How to work with Qualified Medical Interpreters

By Julia Page Hensen, CHI™, National Certified Healthcare Interpreter-Language Access Services Provider, Interpreter Trainer & Consultant

Today we will learn:

• LEP Census Information (at the national, state and county level)
• Federal Mandates and Language Access
• Title VI of the Civil Rights Act
• Section 1557 of the ACA
• When and How to work with an interpreter
• Modes of Interpretation
• Identifying the Need of an Interpreter & Documentation
• Research & the Importance of Working with a Qualified Medical Interpreter

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Who is a Limited English Proficient (LEP) Individual?

• Individuals who do not speak English as their primary language and who have a limited ability to read, speak, write, or understand English can be limited English proficient, or "LEP." These individuals are entitled to language assistance with respect to a particular type or service, benefit, or encounter.

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Number of Languages Spoken in the 15 Largest Metro Areas

States with Highest Share of LEP Residents, (%), 2015�

Washoe County Data

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 Note: Washoe County only has 12 National Certified Healthcare Interpreters

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On LEP.gov, Limited English proficient (LEP) is defined as the population 5 years or older who self-identify as speaking English less than “very well” according to the ACS. 

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Nevada Quick Facts from the US Census Bureau July 2016

Languages Spoken in Nevada & Washoe County

Title VI of the Civil Rights�Act of 1964

• Title VI, 42 U.S.C. § 2000d et seq., was enacted as part of the landmark Civil Rights Act of 1964. It prohibits discrimination on the basis of race, color, and national origin in programs and activities receiving federal financial assistance. As President John F. Kennedy said in 1963:

Simple justice requires that public funds, to which all taxpayers of all races [colors, and national origins] contribute, not be spent in any fashion which encourages, entrenches, subsidizes or results in racial [color or national origin] discrimination.

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Example:

• Treating Medicare or Medicaid recipients - provide access to language services for patients who do not speak English well. The Affordable Care Act expressly extends the protections of Title VI to apply the exchanges.

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How does Section 1557 of the ACA affect interpreters?

• On July 18, 2016, Section 1557 of the Affordable Care Act came into effect. By amending this Section, the Department of Health and Human Services (DHHS) has made the biggest changes to the law pertaining to language access in nearly 20 years.

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• Section 1557 is a “non-discrimination” modification that bans discrimination in health care or health coverage on the basis of: race, skin color, national origin (including immigration status and English language proficiency).

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• Complying with Section 1557 has implications for interpreting services, both spoken and sign language, for utilizing bilingual staff, for translation of documents, and many more other aspects of delivering health care.�

How does Section 1557 of the ACA affect interpreters?

��Meaningful access discussions in which a qualified interpreter is required pertains to discussions involving, but not limited to:�

�Discussions in which a qualified interpreter is not required, and a competent/bi‐lingual employee or family member may be used include, but are not limited to:�

10 Tips for Providers Working with Interpreters:

• 1. Work with a Qualified Medical Interpreter. Do not depend on children or other relatives and friends to interpret.

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• 2. Ensure that the Interpreter is appropriate for the encounter.

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• 3. Hold a brief meeting with the interpreter, if needed.

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• 4. Read body language during face-to-face interpretation encounter. Making eye contact is key to provider relationship.

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• 5. Talk to the patient directly, using first person and not in the third person as in “Tell him xyz”.

10 Tips for Providers Working with Interpreters:

• 6. Be brief, explicit and basic. Pause after a full thought for interpretation to be accurate and complete. If you speak too long, the interpreter may not remember and include everything you say.

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• 7. Don’t ask or say anything that you don’t want the patient to hear.

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• 8. Speak in a normal voice, clearly, and not too fast or too loudly.

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• 9. Avoid jargon and technical terms. Avoid idioms, technical words, or cultural references that might be difficult to translate.

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• 10. Be patient and avoid interrupting interpretation.

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• ***Make eye contact with patient not the interpreter***

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What to expect when working with a Qualified Medical Interpreter (QMI):

• Abides by the National Standards of Practice & Code of Ethics
• Explains interpreter protocol before an encounter to both parties
• Speaks in the first person
• Carry note pad, pen, dictionary or phone w/dictionary app
• Position him or herself to promote eye contact between patient and provider
• A QMI will request repetition or clarification to ensure accuracy and avoid omissions
• Will not allow side conversations

Remote Interpreting Services:

Identifying the need of an interpreter on Storyboard in patient’s chart:

A) Patient’s “Preferred Language” and “Interpreter Needed” information displays on the Storyboard:

1. When a patient is flagged as needing an interpreter, that information appears highlighted in the Story board.
2. Document when you work with a QMI under Physician Note section and include mode of interpretation (in-house, OPI, VRI or other) and Interpreter ID #.

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LanguageLine Report 2020

How does it feel to not speak English

http://www.youtube.com/watch?v=UBLuaoGXOBg

What the Research Says...

LEP Patients are a higher risk for:

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-Adverse Events

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-Medical Errors

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-Misdiagnosis

What the Research Says...

Qualified Medical Interpreters:

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• Reduce the risk for adverse events

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• Increase patient safety

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• Help to meet patient needs, linguistically and culturally

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• Are underutilized!

What the Research Says...

LEP Patients are:

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• More likely to report “being ignored”

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• Harder to connect with emotionally

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• Likely to have a harder time having their needs met

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��Why is it Important to work with a Qualified Medical Interpreter?

Questions

Julia Page Hensen, CHI™

National Certified Healthcare Interpreter

Language Access Services Provider, Medical Interpreter Trainer & Consultant

775-842-4412

jpage@crossculturalservices.com