Should healthcare interpreters in the U.S. be concerned?
April 9, 2018 § 36 Comments
For several weeks I have been contacted by colleagues who provide their services as interpreters in the health sector of the United States. They have all expressed the same sense of confusion, anguish, anger, and uncertainty many of us have noticed in social media and professional forums on line.
This environment started after the decision by the National Board of Certification for Medical Interpreters (NBCMI) to not renew the accreditation of their Spanish language interpreter certification program by the National Commission for Certifying Agencies (NCCA) effective January 1, 2018, and it ballooned after the video of a speech during the California Healthcare Interpreters Association (CHIA) annual conference in Irvine, California in early March was uploaded to the web and watched by interpreters all over the world. Apparently, most interpreters were upset about four things: (1) The decision to terminate the NCCA accreditation; (2) That many learned of this decision by the NBCMI at this conference; (3) That the NBCMI authorities did not informed those candidates scheduled to take the certification exam that the exam they would be taking in 2018, although the same test taken by interpreters certified in the past, was being offered after the Board had quit their accreditation of their Spanish language interpreter certification program by the NCCA; and (4) That many did not like NBCMI’s decision to change the wording on their website portal to show in a casual way, hidden in the text, or at least not highlighted, that they had not renewed said accreditation, and the unofficial explanations and assurances by apparently some people associated with NBCMI that such change would not impact their certification.
I am a veteran of the profession, but like many of you, even though I have interpreted my share of medical events as a conference interpreter, I have never been a healthcare interpreter. Let me explain the healthcare interpreting scenario in the United States.
Healthcare interpreting is an essential part of the health sector in modern society, but despite this and the need to elevate this service to a professional level, healthcare interpreting had a later start than other community-based fields of interpreting like court interpreting.
The United States was no exception, until finally, a few years ago, two organizations took the lead towards the professionalization of the field. Embracing the basic principles and values of the certification program the National Council on Interpreting in Health Care (NCIHC) had written about, the Certification Commission on Healthcare Interpreters (CCHI) and the National Board of Certification for Medical Interpreters developed and implemented two interpreter certification programs. Both understood the overwhelming need to certify interpreters in the most widely spoken foreign languages in the United States, and they both developed a program for interpreter certification in Spanish (there are other languages now. Please visit their websites to learn about the languages covered by each program).
Unlike court interpreting, which developed certification programs sanctioned by the government at its different levels (federal, state, and initially sometimes local), the healthcare sector had no government authority sanctioning the validity of its certifications; and even though this brought healthcare interpreters a professional freedom enjoyed by other professionals like physicians and lawyers, and denied to court interpreters who have no control over the administration of their certification exams, it also created an uncertainty about the validity of their interpreter certification programs.
Because in a private sector-oriented society like the U.S., the situation healthcare interpreter certification programs were facing is not the exception, but the rule, there is a reputable trustworthy entity that solves this problem: The Institute for Credentialing Excellence (ICE).
The Institute for Credentialing Excellence, or ICE, is a professional membership association that provides education, networking, and other resources for organizations and individuals who work in and serve the credentialing industry. ICE is a leading developer of standards for certification and certificate programs and it is both, a provider of and a clearinghouse for information on trends in certification, test development and delivery, assessment-based certificate programs, and other information relevant to the credentialing community. ICE created the National Commission for Certifying Agencies (NCCA) in 1987.
The NCAA’s Standards for the Accreditation of Certification Programs, which were created in the mid-1970s, were the first standards developed by the credentialing industry for professional certification programs. The NCCA Standards were developed to help ensure the health, welfare, and safety of the public. They highlight the essential elements of a high-quality program.
The NCCA standards follow The Standards for Educational and Psychological Testing (AERA, APA, & NCME, 1999) and are applicable to all professions and industries. Certification organizations that submit their programs for accreditation are evaluated based on the process and products and not the content; therefore, the Standards are applicable to all professions and industries. Program content validity is demonstrated with a comprehensive job analysis conducted and analyzed by experts, with data gathered from stakeholders in the occupation or industry.
NCCA accredited programs certify individuals in a wide range of professions and occupations including nurses, automotive professionals, respiratory therapists, counselors, emergency technicians, crane operators and more. To date, NCCA has accredited approximately 330 programs from over 130 organizations.
Accreditation for professional or personnel certification programs provides impartial, third-party validation that your program has met recognized national and international credentialing industry standards for development, implementation, and maintenance of certification programs. This solved the problem for both programs and two certification programs were born:
The Certified Healthcare Interpreter credential (CHI) developed by the Certification Commission on Healthcare Interpreters (CCHI) that offers a certification exam in Spanish, Arabic and Mandarin in 2 steps: First, a core exam consisting of 100 multiple-choice questions, to be answered in English, on medical terminology, healthcare scenarios and ethics; and to those who pass the core exam, an interpreting exam that tests the candidate’s skill on sight and written translation, and simultaneous and consecutive interpreting.
The Medical Interpreter credential (CMI) developed by the National Board of Certification for Medical Interpreters (NBCMI) that offers a certification exam in Spanish, Russian, Mandarin, Cantonese, Korean, and Vietnamese to those who pass (with a score of 70 percent, 80 percent in Mandarin) an interpreting exam that tests skills on sight translation and consecutive interpreting (no simultaneous interpreting or written translation).
Besides competing for interpreter candidates in the same market, both programs needed to convince healthcare providers, insurance companies, patients, and attorneys, that their credentials were reliable, trustworthy, and standard. They started an intensive and successful education campaign that used the NCCA accreditation as one of its most valuable resources.
Even today, CCHI’s website proclaims the validity of its program and skill of its certified healthcare interpreters:
“…Just as healthcare interpreters work hard to get credentialed as “certified healthcare interpreters,” certification programs can also “get certified!” The process is called “accreditation” and, today, it is administered by the National Commission for Certifying Agencies (NCCA), the accreditation arm of the Institute for Credentialing Excellence (ICE). Accreditation is the process by which a credentialing or educational program is evaluated against defined standards by a third party and is awarded recognition when found in compliance with these standards. It’s more than just a voluntary membership in an association. Accreditation (and renewal of accreditation) involves a rigorous process that ensures the quality of examinations and certification offered by organizations like CCHI. In fact, NCCA accredited programs certify individuals in a wide range of professions and occupations, including nurses, pharmacists, counselors, EMTs, HR professionals, defense security specialists, and more. CCHI is proud to represent the healthcare interpreter profession as equal among other allied health professions…today, CCHI is proud to offer the only nationally accredited certifications in the interpreting industry. NCCA’s accreditation validates all aspects of CCHI’s certification programs and CCHI as a certifying body…”
To this day NCCA accreditation continues to be a crucial element of the CCHI program.
Apparently, the National Board of Certification for Medical Interpreters (NBCMI) disagrees with this principle, and even though their website lacks detailed explanations or reasons for the decision not to renew accreditation; some colleagues claim they have unofficially argued that continuing NCCA accreditation is unnecessary because their program is now well-established, the accreditation only covered the Spanish certification program, and their exams have not changed from the ones offered during the accreditation era. Several interpreters have indicated that NBCMI claims that a renewal was too expensive; that they had spent fifty thousand dollars on the initial accreditation, and that their Board had directed those financial resources to the development and administration of certification exams in other languages; activity that would be more profitable.
On its official website, NBCMI addresses its decision to end NCCA accreditation:
“…Prior to 2018, the Spanish CMI certificate was subjected to an additional level of NCCA accreditation, but while the National Board remains a member of the Institute of Credentialing Excellence (ICE), each of the National Board programs have been standardized to ensure the CMI certification in each offered language best meets or exceeds nationally accepted standards, including transparency, inclusion, and access…”
It mentions they continue to be members of the Institute for Credentialing Excellence (ICE), the parent entity of NCCA, and adds a self-serving statement where they praise their own CMI certification. They emphasize their continued ICE membership adding this statement to their official website:
“…As a proud member of ICE, we stay informed on best practices in developing and administering quality certification [certificate] programs so that we may better serve you…”
This could be a simple statement of facts, but unfortunately, it could also be misunderstood by some who may think that continued ICE membership affects their CMI program after January 1, 2018.
ICE clearly tells us what membership means:
“…An organization may join ICE at any time whether or not it has any programs accredited by the National Commission for Certifying Agencies (NCCA). Membership in ICE does not mean that an organization or any of its credentialing programs have been accredited, approved, or otherwise endorsed by ICE…”
Membership in ICE does not mean that an organization or any of its credentialing programs have been accredited, approved, or otherwise endorsed by ICE. We can see this means more than no more accreditation. According to ICE itself, membership means no approval or any other endorsements.
As I write this post, my only goal is for NBCMI to published a written detailed explanation of the reasons they abandoned the NCCA accreditation, the potential consequences this decision can bring to certified medical interpreters, and why candidates scheduled to take the exam in 2018 were not informed of this important change so they could decide to either pursue the CMI certification or perhaps take the CHI exam instead. Spanish language CMI interpreters have a right to know why a certification exam after the NCCA accreditation ended has the same cost as the one offered when the accreditation was in place. How does a business decision to add more languages to the certification program benefit the Spanish language CMIs whose credentialing program lost NCCA accreditation? So far, NBCMI has limited its answer to a statement posted on their newsletter that repeats what they previously said about the validity of the exam and CMI certification, but the explanation of the reasons to discontinue the accreditation have not been disclosed. Dismissing social media as myths and misinformation does not answer the questions so many interpreters want answered.
Some changes have already been impacting those who hold a CMI certification: Some institutions stopped reimbursing the certification exam fee to certification candidates taking the exam in 2018. It has been reported that some clients are now preferring those interpreters holding a CHI certification over a CMI credential; and, a good possibility is that in the future, CMI credentials will be questioned and tested by attorneys who will cross-examine NBCMI certified medical interpreters in the presence of a jury during a medical malpractice trial.
NBCMI needs to explain why NCCA accreditation went from being something they were proud of a few years ago to something no longer needed:
“…The National Board of Certification for Medical Interpreters (NBCMI) is pleased to announce that its Certified Medical Interpreter (CMI) program has been accredited by the National Commission for Certifying Agencies (NCCA), thus joining an elite group of certifying bodies dedicated to public protection and excellence in certification… NCCA accreditation was one of the objectives the National Board set for itself at the very outset…” (NBCMI press release dated January 18, 2013 at Miami Beach Convention Center)
These are valid questions we hope NBCMI will officially address, and they are all legitimate reasons in a free market economy like the United States’ for any interpreter working on the healthcare sector to think very carefully about which one of the two certifications she or he should hold. Let’s hope that at the end of all the confusion and uncertainty the answer is either one of the certifications, but as of today, we do not know if that will be the case, even if both certifications were equally recognized, because one continues to have an accredited certification program and the other one does not. Many of our colleagues would like to know the reason for the changes that both, NBCMI and its parent organization IMIA experienced just now: a new president for NBCMI (we wish her well) and the resignation of IMIA’s president-elect before he officially took office. Interpreters want to know if these changes at this confusing times are related to the decision to end accreditation, or it is just a coincidence.
I now invite you to share your thoughts on this issue, and please, do not write personal attacks, and unless you are officially commenting on behalf of NBCMI, please abstain from sending surrogate comments defending the Board.