September 9, 2021 § 4 Comments
On May 15, 2021 the Certification Commission for Healthcare Interpreters (CCHI) released a study suggesting that an English-to-English exam might solve the shortage of healthcare interpreters in what they call “languages of lesser diffusion,” meaning languages other than Spanish, Arabic or Mandarin. The reason for this “sui-generis” affirmation is very simple: developing actual interpretation exams to test candidates on simultaneous and consecutive interpreting, and sight translation in both: source and target languages would be too expensive and therefore not profitable. Interesting solution: examine candidates’ English language skills (reading comprehension, medical concepts, fill-in the blanks, and what they consider can show the candidate’s “potential correlation with overall interpreting ability”: “listening comprehension.”) An English only exam will catapult an individual into an E.R. to perform as an interpreter without ever testing on interpretation!
What about native English speakers, who in the study scored an average of 87.9% compared to non-native speakers, who scored an average of 76.6%? No problem, says CCHI; passing score is 60% and Spanish language interpreters will continue to take the interpretation exam already in existence. I suppose the expectation might be that people who speak other “languages of lesser diffusion” in the United States have a higher academic background and their English proficiency is higher. Another point that makes this “solution” attractive is that most interpreter encounters in hospitals, offices and emergency rooms involve Spanish speakers, which brings the possibility of lawsuits for interpreter malpractice to a low, manageable incidence. I would add that many people needing interpreting services will not even consider a lawsuit because of ignorance, fear or immigration status. The good news: CCHI concluded that although this English-to-English exam option “is a promising measure…(it)…requires additional revision and piloting prior to use for high-stakes testing.” (https://slator.com/can-a-monolingual-oral-exam-level-the-playing-field-for-certifying-us-interpreters/)
Reading of this report and the article on Slator got me thinking about the current status of healthcare interpreting in the Covid-19 pandemic. How long will the American healthcare system ignore that the country is everyday more diverse and in need of professional, well-prepared healthcare interpreters in all languages? The answer is difficult and easy at the same time.
A difficult answer.
It is difficult because we live in a reality where every day, American patients face a system with very few capable healthcare interpreters, most in a handful of language combinations, and practically all of them in large and middle-sized cities. The two healthcare certification programs have poor exams. One of them does not even test simultaneous interpreting, and the other tests a candidates’ simultaneous skills with two 2-minute-long vignettes (one in English and the other in the second language). Consecutive skills are also tested at a very basic level with four vignettes of twenty-four 35 or fewer-words “utterances” each. It is impossible to assess somebody interpreting skills with such an exam after just 40 hours of interpreter training. (https://cchicertification.org/uploads/CHI_Exam_Structure-Interface-2020.pdf).
Except for those interpreters with an academic background or prepared on their own because they care about the service they provide, the current system provides a warm body, or a face on a screen, not a healthcare interpreter. Because the motivation is a robust profit, it is conceived and designed to protect the interests of insurance companies, hospital shareholders, and language services agencies. It has been structured to project the false impression these entities are complying with the spirit of the law; It is not designed to protect the physician or the patient.
In 1974 the United States Supreme Court ruled that failing to provide language support for someone with limited English proficiency is a form of discrimination on the basis of national origin (https://www.federalregister.gov/documents/2000/08/30/00-22140/title-vi-of-the-civil-rights-act-of-1964-policy-guidance-on-the-prohibition-against-national-origin). The ruling was later broadened and implemented by the Americans with Disabilities Act (ADA) (https://www.ada.gov/effective-comm.htm) and the Affordable Care Act (ACA) commonly known as “Obamacare.” (https://www.hhs.gov/sites/default/files/1557-fs-lep-508.pdf) This legislation specify that healthcare organizations must offer qualified medical interpreters for patients of limited English proficiency and those who are deaf or hard of hearing.
An easy answer.
Despite the reality we face, the answer to the question above is easily attainable because the healthcare industry has immense financial resources and a system that lets them capture money at a scale no other industry can.
The healthcare sector deals with the lives and quality of living of all individuals present in the United States. Their reason to exist is to save lives, not to produce ever-growing dividends to its shareholders every year. This is an industry that spends unimaginable amounts of money in medical equipment, state-of-the-art technology, physicians, surgeons, nurses, therapists, researchers, attorneys, and managerial staff salaries. New expensive hospitals, medical office buildings, clinics, laboratories, and rehab centers are built all the time. This industry can spend top money in those sectors because it is good for business. It is an investment that produces a profit. I am not even scratching the surface of these expenses, but even if we ignore the money spent in food, gear, vehicles (land and air), utilities, clerical staff, janitorial staff, and medical aide positions, we can safely conclude this is an industry that knows how to spend money when an expense is viewed as an investment that will produce a financial benefit.
Designing good medical interpreter exams in many languages is expensive, paying professional-level fees to healthcare interpreters will cost money, managing a continuing education program will not be cheap, but the healthcare sector cannot cry poverty. They have the funds to do it. It is incomprehensible how a business that bankrupts its patients after one surgery or a chronic disease can argue with a straight face, they can only pay 30 to 50 dollars an hour to a medical interpreter. This is an industry that charges you fifty dollars for a plastic pitcher of water or twenty dollars for a box of tissue they replace every day.
Quality interpreting, and living up to the spirit of the law, cannot happen when an organization spends money to look for shortcuts such as testing English-to-English in an interpreting program. Only the promise of a professional income will attract the best minds to healthcare interpreting. Current conditions, including low pay, an agency-run system, and searching for shortcuts to go around the law will never produce quality interpreters.
If those deciding understand good professional healthcare interpreters are an investment as valuable as good physicians, surgeons and nurses, the solution can begin immediately. Designing and administering a quality interpretation exam will take time, getting colleges and universities to start interpreting programs that include medical interpreting will not be easy, but there are steps that can improve the level of interpreting services right away.
A higher pay, comparable to that of conference interpreters will immediately attract top interpreters in all languages, at least temporarily or part-time to the field. Many top interpreters see the need for quality services during the pandemic, and they feel a need to help, but they have to make a living and healthcare interpreter fees do not meet the mark.
Instead of thinking of English-to-English exams to create an illusion they are forming interpreters, stakeholders should recruit native speakers of languages where interpreters are hard to find, but they must stop looking for “ad-hoc” interpreters in restaurant kitchens and hotel cleaning crews, and start talking to college students and professors, to scientists and physicians from those countries who now practice in the United States. With current technology, hospitals should look for their interpreters among the interpreter community in the country where a language is spoken and retain their services to interpret remotely, instead of opening massive call centers in developing countries, using the technology to generate a higher profit instead of better quality.
Hospital Boards must find the money and allocate it to interpreting services. In these cases, such as Medicaid and others, the cost of interpreter services should be considered an operating expense. Insurers do not reimburse for nursing and ancillary staff. Hospitals and practices pay their salaries.
Payers may also benefit by covering interpreter services. Although data are limited according to the Journal of the American Medical Association Forum, studies suggest that when physicians struggle to communicate with patients, they are more likely to order unnecessary tests and treatments. This not only puts patients at increased risk, but also directly increases payer spending. Limited English proficiency patients may need care more frequently or seek treatment in more expensive settings, such as the emergency room, when they cannot communicate with primary care providers. Similar to insurers in fee-for-service arrangements, risk-bearing provider groups in alternative payment models face a similar incentive to curtail unnecessary or wasteful utilization. Poor interpreting services will also result in malpractice lawsuits against hospitals, language service providers, insurance companies and medical staff. In the long run, by far, this makes investing in quality interpreter services and interpreting education/certification programs a smaller expense. “Paying for interpreter services, from cost-based reimbursement, to their inclusion in prospective payment models, to insurer-led contracting of remote interpreters, would not only address the disparities exposed by the pandemic, but also help support practices facing financial peril due to the pandemic.” (https://jamanetwork.com/journals/jama-health-forum/fullarticle/2771859) It is time to grow up and stand up to the stakeholders in the healthcare sector; it is time to unmask the real intentions of language service providers who take advantage of often-poorly prepared interpreters to get a profit. It is time to have a serious healthcare interpreter certification exam that really tests the candidate’s interpreting skills. We need university and college programs, and a different recruitment system led by hospitals and insurance companies not multinational interpreting agencies, or ill-prepared small local players. Interpreters cannot be made in 40 hours and we can’t have newly trained interpreters learning at the cost of real patients’ safety. The pandemic showed us the importance of healthcare interpreting, let’s seize the opportunity to professionalize it.
March 12, 2018 § 5 Comments
The irregularities on the administration of the United States federal court interpreter certification exam of 2017 prompted a debate among many colleagues, seasoned court interpreters, those who took the test and are still living in the uncertainty this first appearance by Paradigm unexpectedly brought to their lives, and everybody in between. There are many unanswered questions about the way testing was handled, and there will be plenty of them once the results are announced one day. It is unlikely that once the candidates who feel the “sui-generis” administration of the test significantly impacted their performance are told they failed the exam, they will just accept it and move on. Some colleagues in such situation may be lawyering up just in case. Even those who will be told they passed will face situations never faced by any other federally certified court interpreters before. Maybe the results of their exam will be questioned in some spheres. Sure, the federal judiciary will tell them that their certification is as valid as anybody else’s.
That will be true because the certification will be issued by the same Administrative Office of the United States Courts, and they will be retained to interpret in court just like everybody else. Unfortunately, assignments by others, such as law firms and their clients, could bring them some headaches. Everybody other than the federal judiciary is in the private free market where they can hire any interpreter they please. Some potential clients may show reservations, as unfair as it may look to many of us, about the reliability and skill of an interpreter certified on the year of the messy administration of the test. There will be many potential clients who will not care, but sadly, some will, and a possibility is that some of those who will could be the biggest players, the ones who pay the higher fees and handle the high profile cases. This ugly situation, out of the interpreters’ hands, could punish excellent interpreters able to pass the exam, whose skills would never be questioned but for the careless administration of the exam. I hope this does not happen, but it could.
During this, the darkest hour of the federal court interpreter certification exam’s history, I noticed certain things that led me to believe that besides the exam, there are misconceptions about the U.S. federal court interpreter certification.
Setting the current situation aside, the federal court interpreter certification exam is a prestigious exam that measures, to a high degree of reliability, the knowledge and skill of a candidate by testing them on all modalities of court interpretation, criminal legal proceedings, specialized terminology, and language fluency. The exam shows if a candidate meets the minimum standards to provide interpreting services in federal court. Passing the exam is just the beginning, not the end. It does not take us to the finish line, it is just the first step on the track. It troubles me to read comments by colleagues who claim they have not picked a book since they took the test 5 months ago; it concerns me to see how some believe they already forgot so much they think they would fail the exam if they had to take it again.
I worry when I read we have colleagues waiting for the test results to decide where to move permanently to apply for a job in a federal courthouse. I also hear how many candidates believe that, because there is a need for court interpreting services at the federal level, they will be getting tons of work as freelancers in the federal system. First, there are few openings to work full time as a staff court interpreter; to get the job they would have to beat many other more experienced and better known applicants, plus government budgetary concerns which favor a hiring freeze.
They will get work at the federal courthouse, but not as much as they expect. They will soon realize there is a huge difference between the caseload of a federal and a state or county courthouse, next, they will learn that very few cases go to trial in the federal system, that many hearings requiring interpreting services are covered through TIP (Telephone Interpreting Program) with the interpreter working from a courthouse far away. The newly certified court interpreters will be exposed to the strict (compared to most states’) guidelines and policy requiring that the courthouse hire the services of all certified interpreters in the area in a fair and even manner. There is a rotation in several courthouses to meet this policy. Finally, they will come to understand that most assignments given by a courthouse are for half days.
I also get the feeling that some candidates, and even some certified court interpreters, believe the federal court interpreter certification is the panacea. They assume that their certification will get them conference work, electronic media interpreting assignments, and so on. This is false.
A United States federal court interpreter certification in Spanish is proof that the interpreter passed the toughest court interpreter exam in the United States, that she or he has demonstrated to have the minimum qualifications to work in the federal criminal court system, those with the certification can be responsible professionals and reliable individuals who value professional self-improvement to the point they put themselves through the arduous certification process. That’s it.
It does not mean that the certified interpreter has the knowledge and skill to interpret a criminal trial; that is acquired through practice, experience, and constant study. It does not even mean that the interpreter has the minimum skills and knowledge to interpret a civil proceeding. The exam tests no knowledge of Civil Law.
As cherished as a U.S. federal court interpreter certification is, it means little in the world of conference interpreting, or in any other interpreting field. There are excellent conference interpreters who started (and continue to work) in the courts, but their success outside the court setting does not come from the court interpreter certification, it comes from their individual effort and determination to study and prepare as conference interpreters, understanding that the two disciplines are different. I get scared when an agency offers me a conference assignment and tells me they only hire conference interpreters who are federally certified court interpreters. This tells me they are an agency that provides community interpreting services (including legal and healthcare) and that the assignment offered is probably not very good. I have never known of any reputable agency that works with conference interpreters say such a thing. It is the same for healthcare interpreting, that is why there is a different certification to work in hospitals and physicians’ offices.
I sincerely encourage all those waiting for the conclusion of this 2017 federal court interpreter certification exam soap opera, to look closely at their expectations as interpreters certified to work in federal court, and once they understand what they got, and what they did not, to study, practice, and plan their work as a professional interpreter with an eye on the future and both feet on reality, and make the choices right for each one in order to succeed not only as federally certified, but as professional interpreters. I now invite you to share your thoughts on this subject.
May 1, 2017 § 3 Comments
Many of us have devoted years to the struggle to achieve recognition towards the professionalization of what we do. In most countries, interpreters need not have a college degree, the occupation is highly unregulated, and society lacks the knowledge to demand a high-quality professional service. An important number of countries have exercised to a degree some control over who can interpret in certain fields: legal and healthcare interpreting now requires of a certification in several countries. Whether it is called certification, patent, license, or anything else, this is an important step towards professionalization. It is a way to compensate the lack of formal education by giving individuals a chance to demonstrate that they have the minimum skills to practice as interpreters. It reminds me of the beginnings of other now well-established professions. Two centuries ago, people in the United States could become lawyers by passing the State Bar without having to attend Law School.
Although certification does not guarantee the quality of a rendition, it allows the user to decide if an individual is at least minimally qualified to provide the service. This quality-control becomes very valuable to society, but we must be very careful as it is not always what it should.
All professions certify, admit to practice, or something to that effect, their members in one of two legitimate ways: By an administrative act sanctioned by a government because of passing a knowledge and skills test, or, by an administrative act sanctioned by the individual’s peers through a professional association because of passing a knowledge and skills test.
In the United States, and other countries, court interpreters acquire their certification through the former system, while healthcare interpreters get their credential through the latter.
Both systems work fine because they meet the requirements that guarantee an unbiased decision solely based on merit, not self-serving reasons. Besides meeting certain moral and legal requirements, this is achieved by passing a scientifically developed exam rated by an impartial qualified jury. Certifications can only be universally accepted and recognized when they come from such a process. For this reason court and healthcare certifications have become the standard of the profession in many countries.
Unfortunately, because of the lack of legislation, the high demand for inexpensive interpreter services, lack of knowledge by the potential client, and the existence of paraprofessional interpreters willing to work for next to nothing for their quality-absent services, have created a perfect storm for worthless so-called “certifications” that currently inhabit the market in the darker corners of the ugly face of interpreting, feeding themselves on the ignorance, fear, and cowardice of the pariahs of this profession.
Many language agencies advertise their interpreters as “certified” because they have been tested online or by phone and passed an unscientific exam not developed to learn if an applicant is prepared with the minimum professional skills to do the job. Instead, the motivation behind these “exams” has to do with marketing the service, and protecting the agency if a lawsuit occurs caused by the incompetence of their so-called “certified interpreters”. No data is available on the science behind their exams, and there is no information on the quality and impartiality of those rating the examinees.
It gets even worse: many community interpreting, telephonic interpreting, and supposedly healthcare and legal interpreting agencies advertise as “certified” interpreters individuals who attended a workshop, took a class online, read a manual, or went to a class without even taking an exam! The website of one agency brags about the “training” of their “certified” interpreters taught “national ethics and standards of practice for interpreters” in the United States. The problem is there is not such a thing. Each field has its own code of ethics. It also claims that their “certified” interpreters, who apparently work in legal situations, get “…basic skills pre-session preparation…” and they also get skills on “…closing the session…” These are no doubt important issues in healthcare interpreting, but not even the terminology exists in legal interpreting. I wonder how this knowledge, or learning “information on community systems (K-12 schools…)” will show that an interpreter is ready to work in a courtroom, detention center, or law office. Some brag about the number of training hours they offer to their interpreters, but they do not require that they pass an exam; much less a real scientific exam like the ones real certified interpreters must pass. Most of the training hours are devoted to practices to protect the agency from liability, to make the business plan more profitable. Whether they require an online test or just a bunch of classroom hours on a curriculum they created, they have as their main goal to create this impression that their interpreters are certified. They never disclose that their certifications are not officially recognized, that their exams were not scientifically developed, or that they have a vested interest: to offer the paraprofessional services of these “certified” interpreters at a lower cost so they can profit more.
This is not the only problem, dear friends and colleagues, official government policy can also be the main obstacle faced by interpreter certification. I was contacted some time ago by the government of a country outside the United States. Mexico’s legal reforms took the country from a written court system to an adversarial oral system similar to the one in the U.S.
I was asked to participate in a training program for the new court interpreters for the oral proceedings. I was told this curriculum was necessary for these interpreters to get ready to pass a (certification) test and get what Mexico’s legislation calls a court interpreter patent (same as the certification in the United States, or the licensing in Texas). I was asked to provide may documents and information, even to develop a prospective curriculum and bibliography for my portion of the training (8 hours a day, Monday through Friday for three weeks). The full program was supposed to have a duration of three months at the same pace, and it was to be taught on the campus of the largest college in that Mexican State (Mexico is divided in States just like the United States of America).
After months of negotiations, where I made many concessions regarding the money I would be paid, and my expense account during the three weeks I would be living in that city, and after agreeing to cover my own airfare, to get these young prospective court interpreters what they needed to have a successful and meaningful career, the government officials continued to ask for more documents and concessions, until I gave them an ultimatum. At the end the answer was the one I feared all along: They would not retain me for the program because I was too expensive, but also, because I was a foreigner. They decided that only locals could teach the program. I have no problem with the local talent, and I know some of the other instructors and I vouch for their skill and expertise. The thing that puzzled me was that out of all the instructors, I was the only one who was both: interpreter and attorney, and I was the only one with experience working as an interpreter in court. The decision from above, taken by people who know little, or nothing, about court interpreters, left the certification program for that Mexican State with no court experienced instructors.
In the present world where a college education for interpreters is still years away in many countries, interpreter certification programs play a huge role in advancing the career and protecting the user of the interpreting services. Society must know of these malicious self-serving “certification programs” that are roaming out there with no supervision or regulation. It is imperative that more colleagues get certified as court and healthcare interpreters in the countries, and languages, that the credential is offered. On June 1, of this year, my colleague Javier Castillo Jr. and I have prepared a four-day workshop to prepare those who will be taking the oral portion of the court interpreter federal exam in the United States at the University of North Carolina in Charlotte this summer. The workshop will also help those taking court interpreter oral exams at the State-level, as we will dissect the test, explain what matters to get a passing score, and will practice with tailor-made exercises designed for these workshops you will find nowhere else, so that when the four-day program ends, those who took the course can get a personalized evaluation and know exactly what to do to pass the test. (You can get more information by going to www.fciceprep.com)
As you can see, the road to professionalization is full of obstacles, and some need to be eliminated to get the needed recognition to those legitimate certifications. I now invite you to share with the rest of us your comments on this issue.