Should healthcare interpreters in the U.S. be concerned?

April 9, 2018 § 36 Comments

Dear colleagues:

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.

Will my clients find me in this association’s directory?

April 17, 2017 § 10 Comments

Dear Colleagues:

I am tired of getting this call repeatedly: “Hi, I got your name from the ATA directory and I was wondering if you would be available for a medical evaluation (or a worker’s compensation hearing) this Friday…”

Maybe those providing the service would be happy with these calls, but I am not.  Every time I must answer the phone to tell somebody I don’t do that work, and that I refuse to work for peanuts, is a waste of my time.  I do conference interpreting and I don’t like to explain two or three times a week I do not work for fifty dollars an hour.

For years I have almost exclusively worked as a conference interpreter, doing some court or legal interpreting for established Law Firms I regularly work with, generally in civil cases or some federal criminal matters.  Motivated by ATA’s outreach campaign regarding the credentialed interpreter designation and database, I thought that maybe, if I clarified it on the ATA directory that my credentials are United States Department of State Conference-level, and Federal court certification, all these people would stop calling asking me to do work that I do not provide.

I have been an ATA member for many years, and even though the association does many things I am very much against, I also get many benefits from my membership: a monthly publication with some very good articles, a discount on my errors and omissions insurance, good divisional activities, valuable webinars, and a well-known directory.

I logged in to the members section of the website to update my information and take advantage of the new credentialed interpreters’ database in their directory. This happened:

I must start by confessing that I rarely access ATA’s website, so I found it a little bit too crowded; maybe appealing to translators, but I believe it could be a little intimidating for clients looking for an interpreter or translator. After I accessed the “members” section, I looked for a section called “Interpreters’ credentials”, or something similar, but I found nothing. I clicked on the menu where it says “update your contact information” and “update your online directory profile”.

As I got to the profile section, all my information was already there (so I had entered it before). I did not need to change anything. Since I was already inside the program, I reviewed it anyway to see if I needed to make any changes. When I got to the “Interpreting Services” section, I saw that I had previously highlighted “consecutive”, “court”, “escort”, and “simultaneous”. Since I saw a “court” category, I scrolled down to see if I could also highlight “conference”, but the only category left for me to highlight was “sign language”. I thought it was odd. On one hand, if all you are listing are the interpreting you do, then “court” does not belong in here. If they added “court” to make the search easier for the clients, then I would like to see “conference” as an option. I suppose that healthcare interpreters would argue the same for their specialization.

Under the “Certifications” section, I entered my federal court interpreter and my two state-level court interpreter certifications from the drop down menu. I saw nothing for other credentials that are not certifications, but equally important, such as AIIC, U.S. Department of State, European Union, etc. The menu had another category: “other” where I entered my conference interpreting credentials, constantly wondering why I could not find the so much talked about “credentialed interpreter” menu for the new database ATA has been advertising so much. I thought the reason the place to enter that information was somewhere else, perhaps later on the form, was because these other credentials are not certifications and ATA had included them separately.

I kept looking, and my search only found a different category towards the end of the page called: “Additional Information”. That was it. No other place to enter conference interpreter credentials. Knowing I would not get what I wanted, I tested the directory, so I looked myself up. On a simple search I found my information, not as advertised with the credentialed interpreter information, but as I had entered it earlier. I immediately thought of the unwanted agency phone calls that would keep on coming as before.

I ran an advanced search just for English<>Spanish interpreters in Illinois, where I live, asking for State Department conference-level credentials, and the result was “we found none”.  I found this interesting, so I dug deeper to see if there was a problem with the directory search engine. The first thing I tried was a search for interpreters with that same language combination and credentials in the largest state: California. I know several colleagues there with the credentials and are members of ATA. The result was: “we found none”.

At this time I decided that maybe it was a glitch on the search engine, but before concluding that, I wanted to see if I had missed the section where you enter these credentials. I went over the form two more times and I found nothing. At this point I am thinking that maybe I needed to submit my credentials for a verification before the information was displayed, so I went back to the form once again. I read it carefully looking for some instructions or description of such process. I found nothing.

I did the only thing left: I went to the search menu at the top of the page and I typed: “credentialed interpreter process”. The search took me to a page with all the results. At the top I saw one that looked like the information I was looking for, so I clicked on it.

I finally found the explanations and instructions, with a link to a form to start the process. The first thing the program asks you to do is to reenter your ATA membership information. Once you are in the form, you are greeted by a message in red that tells you to submit a separate form for each credential and that you must pay $35.00 USD. As an attorney I must confess that although the red-inked message clarifies that one fee covers all requests, it is ambiguous on a second matter: it reads: “A $35-administrative fee covers all requests for one year.”  I did not understand if this means that for your information to continue to be available indefinitely you must pay $35.00 USD every year, or that any request filed after twelve months is no longer covered by the initial $35.00 USD fee and therefore you must pay again for the new credential.  Finally, I also learned that the process could take up to something like forty days.

After reading this, I stopped for a minute and reflected on what I was about to do: I was ready to send $35.00 USD to ATA (with my documentation) to be a part of this new database, but so far I had had a miserable time looking for, and finding any colleagues with the desired credentials; so far I had found zero conference interpreters. I even had a difficult time finding the instructions to get my credentials reviewed.  My friends, I am pretty active on social media, and even though I am not a computer genius, I am resourceful. Can you imagine how tough it would be for a regular individual looking for an interpreter to navigate through these? Even if I do this, send the documents, pay the fee, and wait the forty days, will my clients find me?

I concluded that I had to do more research first, so I did.

I went back to the directory and tested it:

I did this trying to think like a client and not like an interpreter or an ATA member. The first thing I noticed was that to look for an interpreter, the person doing the search must go through the translators’ section of the advanced search; they must scroll down passing through a section with very confusing questions for somebody who, let’s say, wants to hire an interpreter for a marketing conference at the Marriott downtown. Without being an interpreter, I would not know what to do when asked to indicate if I want an ATA certified or non-certified translator, or what translation tools I will need. As a client, even before reaching the interpreter questions, I would probably close the page and look for a conference interpreter in Google or somewhere else.

Since I had already tried Illinois and California with a result of zero interpreters, I looked first for any conference interpreters with an English<>Spanish combination, with a U.S. Department of State Conference-Level credential in New York State. The result was: none. Then I did the same thing for Washington, D.C. (where most conference interpreters live) Again there were zero. I got the same result in Florida and Texas. Next, I searched the same states for any interpreters with the same combination, but with the AIIC membership credential. The result was: nobody. I considered doing the same for every state in the Union, but (fortunately) I decided against it. Instead, I looked for any conference interpreters with any credential and living anywhere in the world. The result was: 2 interpreters. One U.S. Department of State Seminary-Level colleague in the United States, and one AIIC member in Argentina!

Based on these results, I looked for interpreters in all listed categories. I found this: Under certified court interpreters I found 10 colleagues. Under Healthcare certified I found 4 (2 were also listed as part of the 10 court certified). Under conference credentials I found 2 (one of them is also one of the 11 under court certified). I found 1 telephonic interpreter (also found under another category), and I found zero sign language interpreters.  Looking for simultaneous interpreters I found 10, under escort interpreters I saw there are 9, and as consecutive interpreters they have 14. As expected, all interpreters under the modes of interpretation categories are the same ones listed by specialization. I also noticed that some interpreters I found in this group are ATA Board members.

The page also asks the person doing the search to state if they are looking for a “consecutive, court, escort, sign language, simultaneous, or telephonic” interpreter. My relevant question was stated before in this post, but it is worth repeating for another reason: If I am a client looking for a conference interpreter, how can I find one under this criteria? Ordinary people do not know that conference interpreters do simultaneous interpreting. Even worse, they also do consecutive interpreting in many events such as press conferences for example.

If people we deal with regularly have a hard time referring to consecutive or simultaneous interpreting by their correct name, why would everyday people looking for a conference interpreter know who they need based on this question? If ATA included “court”, and even “telephonic”, they should include conference. Once again, I am sure my healthcare interpreter colleagues want to be heard here as well.

After reviewing the directory my decision was simple. Why would I want to pay $35.00 USD, and perhaps wait up to forty days, to be part of a directory listing a microscopic portion of the interpreting community? Should I encourage my clients to look for a credentialed conference interpreter in a directory that does not even list us as an option, and flatly ignores conference interpreting in their most common questions section, where all explanations and examples are geared to court and telephonic interpreting? And why as interpreters should we reward the work of an association that continues to treat us as second-class professionals by including the interpreter search criteria after the translator search options, instead of having two separate search pages: one for interpreters and one for translators to make it easier for our clients, and to give some respect to the many interpreters who are ATA members? There is no excuse or justification for this.

I know there are plenty of capable people at the helm of the American Translators Association whom I know and respect as friends and colleagues. I also appreciate many of the good things they do for the profession, but at this time, for all these reasons, until we interpreters get from ATA what we deserve as a profession: Unless the search criteria and credentialed interpreter designation process is as prominently displayed on the website as is the translators’ certification; and only when the search criteria addresses the conference interpreter community on a client-oriented, user-friendly platform, I will stay away from the “advanced-options” directory. I hope this post is welcomed as constructive criticism, and as the voice of many interpreters all over the world. It is not meant as an attack on anybody; it is just an honest opinion and a professional suggestion from the interpreters’ perspective. I now invite you to share with the rest of us your thoughts about such an important issue for all interpreters and for the image of ATA.

Who are those “top-level” interpreters many agencies refer to?

March 26, 2015 § 16 Comments

Dear colleagues:

I am sure that what I am about to describe has happened to many of you: You get an email from an agency either telling you that they are new to your market and they are looking for “top-level” interpreters in your area, or they address you directly by email to let you know that they have an upcoming project and they would like to have you on board for the event. Both emails end by asking for your resume, fee schedule, and sometimes even references.  I have basically received this email, or similar ones, innumerable times during my career.  I do not know what you do when you get such a request, but I usually respond to the communication by email. I attach the most recent version of my resume, a boilerplate letter that details my fee schedule, accepted payment options, cancellation fees, and travel expenses requirements; and when the agency asks for references, I just state, in the body of the email, that I will only ask my clients for references when the assignment offer is firm, and in the meantime I suggest they google me under: “Tony Rosado Interpreter” and they will find many pages that talk about me, including professional achievements, publications, interviews, and testimonials. I have found that in most cases, this strategy works. It is common for prospective clients to waive the references requirement after they have googled my name.  To me, this is standard practice because I do not like to bother my regular clients unless it is absolutely necessary, and I value my time too much to be happy about spending time collecting reference letters for agencies who have not even extended a solid offer.

Now, what happens after I send the information can be classified in three categories: The exceptionally rare, the exceptionally common, and the deafening silence.

Every once in a while the agency contacts me after I emailed all the information and offers me the job.  This is not a common occurrence and sometimes I have to work a little harder to get the fee I command. Things like an explanation of the work I do, sharing my professional experience, and bringing up potential problems that the client had not thought about, will get me the fee requested on my fee schedule.  Usually, these agencies turn into regular clients after the first assignment as they are serious about customer service and quality interpreting. Of course, most of our work comes from agencies that already know us, or from those who were referred to us by another client or colleague, but we should never discard unknown agencies who reach us by email, unless the communication sounds like a scam, a pipe dream, or we hear about their bad reputation.

The overwhelming majority of these agencies contact me back to thank me for my quick response, and to tell me that my fee schedule is way above their means. Some of them end the communication after this revelation, and some others let me know that they will keep my information, and when they get an interpreter request for an event that “…requires of someone with my experience and credentials… (they)… will contact me”. That is usually the last I hear from the agency.

The rest of the agencies never get back to me. They simple apply the “silent treatment”.  I imagine that their reasons for totally ignoring me have to do with my fee, payment policy, or my travel requirements, but I will never know for sure.

Now, if you are like me, before answering the original email, you do a little research on the agency. I run a search on the web, and when they have a website (it is a bad start when they do not even have one, or the one they have is one of those free websites full of commercial advertisement) I read it very carefully. Although the wording changes from one website to another, all of them promise top-notch, professional and experienced interpreters. This is what gets me thinking. When the agency does not answer back after I send them my resume and fee schedule, or when they respond to let me know I am too expensive for them, I cannot help it but wonder who are they hiring for these assignments?  I know many interpreters and I believe that, at least by name, I am aware of practically all of the top-level interpreters in my language combination. Certainly, I know every name in my region; I have to: this is my market and I am trying to provide a professional service.  Sometimes I ask around, sometimes the information comes to me without doing a thing, you all know how it is in this profession: information gets around.

For this reason, it puzzles me how these agencies can claim that they provide top-notch, experienced interpreters when, as interpreters, you know all those who would fit the description, and many times even the ones one tier below, and none of them was retained to provide the service. Are these agencies being honest with their customers when they promise the best of the best? I do not know for sure, and I am not accusing anybody. I just wonder who these “top-level, experienced” interpreters are, and where are they finding them. I would love to meet them, get to know them, and ask them how they can make a comfortable living when they provide their services for such lower fees. I just do not understand; even if I were to assume that they are all brand new interpreters just out of school and therefore (although erroneously, as I have discussed it many times before) willing to work for a lower fee, how would they meet the “experienced” part of the offer?

I am extremely confused, but maybe you are not, and for that reason I invite you to tell me who are these top-level, experienced interpreters these agencies are offering to their customers. In the meantime, I will share this post with clients and prospective clients to see if they can help me solve the mystery, and in the process, I will inform them that the “top-level, experienced” interpreters I know are not been retained by these agencies.

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