National_Standards_5-09-11.pdf

in health care National Standards for The National Standards for Healthcare Interpreter Training Programs, produced by the National Council on Interpreting in Health Care (NCIHC), is the result of a systematic, deliberate and reflective process. The NCIHC is confident that this document represents...

in health care National Standards for The National Standards for Healthcare Interpreter Training Programs, produced by the National Council on Interpreting in Health Care (NCIHC), is the result of a systematic, deliberate and reflective process. The NCIHC is confident that this document represents the standards that working interpreters and interpreter educators in the United States believe are important in the preparation of healthcare interpreters for entry into practice. The document is designed as a guide for both interpreters and the healthcare systems in which they work, and is not meant to supplant or expand policy or regulations pertinent to the provision of competent interpreter services or the training of interpreters. The NCIHC regrets any inadvertent result which may arise from the application of these standards for training programs. An electronic copy of this document is available on the NCIHC website at www.ncihc.org. National Council on Interpreting Healthcare Irpreter training Programs Funded by a grant from National Council on Interpreting in Health Care www.ncihc.org April 2011 i CONTENTS COMMITTEE ii BOARD iii ACKNOWLEDGEMENTS iv INTRODUCTION 1 SECTION I: BACKGROUND AND CONTEXT . SECTION II: STANDARDS 3 I. Program Content Standards II. Instructional Methods Standards III. Programmatic Standards 9 9 16 21 GLOSSARY 26 REFERENCES 37 © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. ii COMMITTEE PREPARED BY THE NCIHC STANDARDS, TRAINING AND CERTIFICATION COMMITTEE Co-chairs Karin Ruschke, MA President, International Language Services, Inc. Interpreter Trainer, Program Development Consultant Shiva Bidar-Sielaff, MA (through May 2010) Director of Interpreter Services and Community Partnerships University of Wisconsin Hospital and Clinics Cynthia E. Roat, MPH (May 2010–May 2011) National Consultant on Language Access in Health Care Members Maria-Paz Beltran Avery, PhD Managing Director, Education Development Center, Inc. Julie Burns, MEd State of California Workers Compensation Certified Medical Interpreter English/Spanish American Translators Association-Certified Translator Spanish into English Certification Commission for Healthcare Interpreters – Certified Healthcare Interpreter™ Adelya Carlson, MEd Director, Training and Outreach Northern Virginia Area Health Education Center Bruce Downing, PhD Associate Professor Emeritus, Linguistics Former Director, Program in Translation and Interpreting University of Minnesota Carola E. Green Federal Court Certified Interpreter Coordinator for Court Interpreting Testing Services and Operations, Research National Center for State Courts Katherine Langan, PhD Interpreter/Translator III, Trainer Mercy Medical Center, Des Moines, Iowa Orlin Márquez, RN, BSN, MBA Practice Manager—Physiatry/Rehabilitation Children's Healthcare of Atlanta at Scottish Rite Immediate Past President, Medical Interpreter Network of Georgia (MING) © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. iii BOARD REVIEWED AND APPROVED BY THE NCIHC BOARD OF DIRECTORS, APRIL 2011 Enrica Ardemagni, PhD, Co-chair of the Board Joy Connell, Co-chair of the Board Maria Michalczyk, RN, MA, Treasurer Jorge Ungo, Co-chair, Finance Committee Dijana Rizvanovic, Co-chair, Membership Committee Jason Roberson, MA, Co-chair, Membership Committee Mary Esther Diaz, MEd, Co-chair, Organizational Development Committee Lisa Morris, MA, Co-chair, Organizational Development Committee Paz Angélica Snyder, Co-chair, Outreach Committee Fabio Torres, MACCM, Co-chair, Outreach Committee Wilma Alvarado-Little, MA, Co-chair, Policy and Research Committee Doreena Wong, JD, Co-chair, Policy and Research Committee Cynthia E. Roat, MPH, Interim Co-chair, Standards, Training and Certification Committee Karin Ruschke, MA, Co-chair, Standards, Training and Certification Committee Gem P. Daus, MA, Executive Director © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. iv ACKNOWLEDGEMENTS NCIHC would like to thank the Project Advisory Committee, as well as our expert consultants, for their commitment to this project and their invaluable input. Project Advisory Committee Marjory Bancroft, MA Eduardo Berinstein, FCCI Agustín de la Mora, FCCI Nora Goodfriend-Koven, MPH Marilyn Mochel, RN Elizabeth Anh-Dao Nguyen, MA, AHI Robert Pollard, PhD Laurie Swabey, PhD Amy Wilson-Stronks, MPP, CPHQ Expert Consultants Robyn Dean, MA, CI/CT Gregory Figaro Catherine Ingold, PhD We would also like to thank Priscilla Mendenhall and Stergios Roussos, PhD, for their work on the literature review. Our special thanks go to the Certification Commission for Healthcare Interpreters (CCHI) for its permission to use its Healthcare Interpreter Body of Knowledge study as the foundation of our job task analysis. We would like to recognize the following organizations, which generously allowed us to review their curricula for healthcare interpreters: Cascades East Area Health Education Center, City College of San Francisco, Cross-Cultural Communication Systems, Inc., Culturesmart, Inc., Cyracom, Massachusetts AHEC Network, Portland Community College’s Center for Advancement, The Cross-Cultural Healthcare Program, the University of Arizona’s Department of Spanish and Portuguese Modern Languages, and the University of Minnesota’s Program in Translation and Interpreting. Finally, we would like to specially recognize the many interpreters, interpreter educators, and other individuals who participated in our focus groups and responded to our surveys. These standards reflect their work and vision for their profession, always with the goal of supporting limited-English-proficient patients and the providers who serve them. © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. v National Standards for Healthcare Interpreter Training Programs INTRODUCTION Over the past decade, formal training opportunities for interpreters in health care have increased significantly across the United States. In 1994, when the group that would become the National Council on Interpreting in Health Care (NCIHC) first met, both the practice of healthcare interpreting and formal preparation of healthcare interpreters were in their infancy. To raise the quality of healthcare interpreting and to standardize and advance the profession, the NCIHC embarked on the following five-step strategy:  Document the national dialogue on the role of the healthcare interpreter.  Develop a nationally vetted code of ethics for healthcare interpreters.  Develop nationally vetted standards of practice for healthcare interpreters.  Develop nationally vetted standards for healthcare interpreter training.  Establish a national certification process. In 2001, NCIHC published a conceptual paper summarizing the national dialogue on the complex role of the healthcare interpreter as it had evolved since the early 1990s. The National Code of Ethics for Interpreters in Health Care was published in 2004 and the National Standards of Practice for Interpreters in Health Care were published in 2005. In 2007, work began on developing national standards for training programs. At about the same time, a separate effort to certify healthcare interpreters was launched, supported by the NCIHC and other organizations. © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 2/37 Understanding that programs to equip potential interpreters with both key knowledge and foundational skills would need to be available to raise the quality of healthcare interpreting, the NCIHC focused its work on developing national training program standards. While by 2007 the formal preparation of healthcare interpreters had improved significantly in many parts of the country, vast differences in the quality and comprehensiveness of programs still characterized the training landscape. It was hoped that the availability of carefully crafted and nationally vetted standards would help to both standardize and increase the quality of training for interpreter candidates across the country. This document presents standards for the formal preparation of bilingual or multilingual individuals who wish to enter the healthcare interpreting profession. The standards are intended to serve as a guide for the development and ongoing review of ―entry-into-practice‖ healthcare interpreter training programs—that is, programs designed for individuals who wish to acquire the background knowledge and foundational skills that every healthcare interpreter needs to demonstrate in order to function independently. The standards are built on the best knowledge and expert opinion available to date about what every interpreter needs to know and be able to do and the most effective instructional methods for helping interpreter candidates master these knowledge and skill areas. We anticipate that as the profession of healthcare interpreting matures, these standards will need to be reevaluated. Until then, they are intended to provide a common and consistent base for healthcare interpreter training programs in the United States. The document is organized into the following sections:  Section I: Background and Context. This section presents the background and context in which the standards for healthcare interpreter training programs were developed.  Section II: The National Standards for Healthcare Interpreter Training Programs. This section presents the standards themselves.  Glossary: The glossary defines specialized terms used in this document. © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 3/37 SECTION I: BACKGROUND AND CONTEXT Why Standards for Training Programs? Although the formal preparation of healthcare interpreters has progressed significantly since the early 1990s, vast differences still exist in the rigor and comprehensiveness of programs. Trainings may last anywhere from 2 hours to 200 or more hours. Some cover only the Code of Ethics, while others focus principally on medical terminology, and still others incorporate both interpreting theory and skill-building. The languages chosen for instruction or skill-building also vary considerably. Some programs are taught only in English, others are taught in English with varying amounts of bilingual skill-building practice in the trainees’ languages, and still others are taught bilingually for specific language pairs. Classes meet in person, over the telephone, or over the Internet. Some programs screen potential students for linguistic proficiency in English, others screen for proficiency in the other language(s) used in interpreting, and some require no language screening at all. Some have clearly defined performance expectations for those who complete the programs while others simply acknowledge student attendance. Recognizing that the advent of national certification presupposes that quality training programs should be available and that foundational knowledge and skills for healthcare interpreters should be standardized, these standards set minimum requirements for what needs to be taught and, more importantly, learned before a candidate can practice as a professional healthcare interpreter. Development Process The NCIHC Standards, Training and Certification (STC) Committee developed these standards using the following process. 1. Review of existing knowledge. Before actually drafting standards, the STC conducted a body of background research. First, the STC reviewed training standards in other fields in order to learn how related disciplines have approached this challenge. At the same time, the committee commissioned a background paper that included a literature review on effective methods for training interpreters and an analysis of 10 documented interpreter training curricula representing diverse settings and duration. The goal of the literature review was to identify what is already known about training interpreters; the © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 4/37 goal of the program review was to identify the breadth of topics and teaching techniques currently being used in a representative sample of healthcare interpreter courses being implemented in the U.S. today. The committee had also planned to conduct a job analysis that identified the core knowledge, skills, and abilities of working healthcare interpreters; however, this became unnecessary when the Certification Commission for Healthcare Interpreters (CCHI) allowed NCIHC access to the job task analysis it had already conducted along with its Body of Knowledge study as background for its national certification exam. In addition, a series of 10 focus groups were conducted across the country. 2. Consultation with an expert advisory committee. A Project Advisory Committee was formed, comprising individuals with extensive experience in fields relevant to interpreter training, such as curriculum development, training practices, and linguistics. Many committee members were also experienced and respected healthcare interpreters and trainers. Establishing such a committee was seen as essential to developing the standards because systematic research on or evaluation of healthcare training programs was lacking. The Project Advisory Committee first met in April 2010 to review the background research and advise the STC Committee on the content and structure of the draft standards. 3. Development of draft standards: An initial draft of the standards was developed, informed by reviews of existing knowledge and guidance from the Project Advisory Committee and feedback from two national online surveys. 4. Feedback from interpreters, trainers, and administrators: Two national online surveys— one for interpreters and another for trainers—provided feedback on the draft standards. In addition, the Project Advisory Committee met a second time in November 2010 to review feedback on the draft standards and make recommendations on their final form and content. 5. Finalizing the standards: Feedback from the online surveys and focus groups and comments from Project Advisory Committee members were carefully reviewed and considered to develop the final set of standards. © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 5/37 This document, which resulted from this 2-year process, presents standards for introductory spoken-language healthcare interpreter training programs, whether based in community, private, or academic settings. Organization of the Standards The standards are divided into three major areas: 1. Program content standards: The content standards identify the background knowledge and foundational skills in which every professional interpreter should demonstrate competency or understanding before assuming full responsibility for interpreting between English-speaking providers of health care and individuals with limited English proficiency (LEP). The premise of the content standards, based on a general understanding in the field, is that every healthcare interpreter, including a novice, needs to be competent in certain core skills—such as consecutive conversion skills—in order to practice independently, while other more advanced skills—such as fluid simultaneous interpretation—can be developed after an interpreter starts working. 2. Instructional methods standards: The instructional methods standards draw on principles of adult learning and recognize that interpreting is a skill-based profession. These standards, based on research in other fields of interpreting and on the collective experience, practice, and expertise of healthcare interpreter trainers, present a consensus on best instructional practices for preparing healthcare interpreters, with a strong emphasis on skills development supported by an understanding of why and how these skills are best applied. 3. Programmatic standards: The programmatic standards set out operational practices and policies that contribute to a quality formal training program and include recommendations on instructor qualifications and requirements for entry into interpreter training programs. Some flexibility in implementing these programmatic standards will, however, be required in order to address the unique circumstances and characteristics of potential candidates from diverse languages, cultures, national histories, and histories of immigration and internal migration in the United States. © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 6/37 Audience These National Standards for Healthcare Interpreter Training Programs provide guidance to training program developers as well as program administrators, trainers, interpreter candidates, consumers of interpreter services, and others concerned with the competence of interpreters and the quality of interpreter services. 1. Program developers and training program administrators can use the standards to evaluate and improve the comprehensiveness of existing programs, expand existing programs, or design new programs. Compliance with these standards increases a program’s credibility. 2. Trainers can use the standards to assess their choice of instructional practices and content, keeping in mind the goal of developing their students’ ability to apply their knowledge and demonstrate competency in the foundational skills. 3. Interpreter candidates can use the standards as a guide to assessing the quality of training programs they are considering or the adequacy of programs they have completed. In addition, the standards help inform interpreter candidates about the knowledge and skills they must acquire to practice as competent professionals and to prepare for certification. 4. Consumers of interpreter services, especially employers, can use the standards as a reference for what they can expect from interpreters who have completed entry-intopractice training. Scope of Application of the Standards The National Standards for Healthcare Interpreter Training Programs recognize that many programs are currently not designed or able to cover every component in the standards. The standards are presented as a goal to aspire to as the field of healthcare interpreter training evolves. Thus, the standards are intended to apply to all training programs regardless of their duration or sponsorship—whether training dedicated staff interpreters, dual-role interpreters with other job responsibilities, or freelance interpreters. Likewise, the standards apply equally to © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 7/37 programs preparing interpreters to work face to face as well as programs preparing them to work remotely. Whatever the nature of an interpreter’s employment relationship, the principal goal of a competent interpreter is always the same: bridging the linguistic barrier in the service of communication between provider and patient. All healthcare interpreter training programs must keep this goal in mind. Particular attention should be paid to how to apply these standards to training interpreters in languages of lesser diffusion, a task which poses unique challenges. As mentioned earlier, these standards are intended to describe what is considered essential; at the same time, the complexities inherent in training speakers of languages of lesser diffusion—especially those persons who are recent arrivals in the United States—need to be recognized and addressed by implementing the standards with some flexibility. For example, training programs may need to reconsider such programmatic standards as those addressing the prerequisites for entry into training. Potential students may come from countries with a history of interrupted schooling or may lack formal educational credentials but show a high level of maturity and understanding of the world. For some linguistic groups, certain content areas may present unique challenges. For example, healthcare concepts in one language may not have lexical equivalents in another. In situations where literacy is not widespread in the culture, dictionaries and other instructional tools may not exist and teaching methods requiring the use of the written word may be ineffective. At the same time, programs must seek creative solutions to these challenges. For example, when assessing linguistic proficiency in languages other than English, the lack of standardized proficiency assessment in a particular language is not a valid excuse to forgo language screening altogether. There are many ways to determine a candidate’s level of proficiency against community standards set by speakers of a particular language. Protocols for assessing the proficiency of speakers of languages of lesser diffusion can be developed based on the consensus of multiple members of the language community. This option demonstrates how creative thinking can address a training standard that might otherwise appear unreachable. Length of Training By design, this document does not specifically recommend how long introductory training programs should be. The class hours needed to learn the content identified in the standards will © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 8/37 depend on a number of factors, including the training program’s resources and the characteristics of the pool of potential students, including their prior interpreting experience, specialized knowledge of health care, and general level of education. The standards focus on the elements of training needed to ensure that interpreters are prepared to interpret competently in their initial professional encounters. If, for practical reasons—for example, the lack of instructors, limited resources, or time constraints—a specific instructional program cannot address all elements of the standards, it should not be considered deficient or unsatisfactory. It may simply need to provide additional training before trainees are ready to interpret on their own. At the end of such training, candidates should be given a ―road map‖ that clearly identifies the competencies they have acquired to date, the additional competencies they need, and, whenever possible, how those competencies can be acquired. The end point of training is determined not by the clock but by the trainee’s readiness for independent professional service. Therefore, preparatory training can be considered complete when a trainee has developed all the competencies essential for independent performance in the role of healthcare interpreter. For this reason, the standards refer to programs of study (possibly including a series of trainings or courses) rather than to individual training programs. Summary The standards that follow represent the careful thought of a large community intimately involved with preparing healthcare interpreters. As mentioned earlier, it is to be expected that the expertise in this nascent field will grow over time and research will provide more concrete data on which to base recommendations. NCIHC hopes that this document will provide both a set of unifying standards for the present and a point of departure for future discussions in this field, with the constant goal of improving the quality of healthcare interpreting to the benefit of limitedEnglish-proficient patients and the healthcare providers who serve them. © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 9/37 SECTION II: STANDARDS I. Program Content Standards Introduction As discussed in the general introduction, these standards reflect broad agreement on the knowledge and skills any interpreter will need before entering into practice, that is, before interpreting independently. Some topics included in this program content section may seem more advanced than would be expected in a basic training. However, in the focus groups and online surveys conducted during the design of these standards, many working interpreters stated that they seldom can choose to interpret only in certain specialties or for ―easy‖ cases— they must be prepared for whatever presents itself in any healthcare encounter. So, for example, while most interpreter training assumes that beginning interpreters must be competent in the consecutive mode, these standards recognize that they will also need at least basic knowledge of and skill in the simultaneous mode. Interpreters will be called upon to do sight translation, already taught in most interpreter training, but also some short translations (such as discharge instructions). They will need a broad range of healthcare terminology and the associated concepts found in varied specialties. And all interpreters should be expected to know something of the legal and social context of their work. As a result, the scope of topics included in these standards may be somewhat broader than expected. At the same time, certain less common and more demanding areas of healthcare interpreting have been omitted here since they can be addressed in advanced/specialized courses or continuing education. These include interpreting for mental health, speech therapy, pediatric specialties, pharmacy, social work, financial services, palliative care, diet and nutrition, smoking cessation, support groups, Emergency Department/trauma, and care conferences. Other topics to be covered in specialized workshops are business practices for freelance interpreters, demographic and socio-historical information regarding patients’ country of origin, as well as migration history and settlement patterns of particular linguistic groups. Local circumstances may determine whether interpreters just entering practice need these or other specific knowledge and skill areas. © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 10/37 This section has been divided into two parts: content related to knowledge and content related to skills. Knowledge about a topic gives the interpreter background and context and often answers the question why: Why do interpreters maintain confidentiality? Why do they use the first person? Skills are demonstrable behaviors that often take practice to learn and perfect, such as accurate conversion skills. While the two sections have been addressed separately to highlight the importance of each, they are best taught in an integrated fashion. So, a lesson on the pre-session would include both knowledge (the reasons for doing a pre-session, the content addressed in a pre-session) and skills (practice doing a pre-session). Regardless of the length of a class or course, it is critical to include both knowledge and skills. Reading this section may raise the question of how one can know if a standard has been met. How much training on the history of healthcare interpreting is enough? How many hours are sufficient to teach accuracy in consecutive interpreting? The standards in this section were not designed to be measured in this way, primarily because no research has been done to establish benchmarks in these areas. These should be seen as initial guidelines. As the field grows and develops, and as more research is done, quantifiable goals can be established and be more defensible. For the present, simply identifying the scope of the content to be included in initial interpreter training is a step forward. Program Content Standards A. Knowledge: The basic program of study exposes the student to the essential body of knowledge that serves as the context for the healthcare interpreting profession. 1. The healthcare interpreting profession: A basic program of study introduces the student to healthcare interpreting as a profession. a. The definition of interpreting as contrasted with bilingualism and translation b. Fields of interpreting (e.g., diplomatic interpreting, liaison interpreting, business interpreting, and community interpreting, including judicial, healthcare, social service, law enforcement, and educational interpreting) c. Ways in which interpreters are employed (dedicated vs. dual-role interpreters, contract or freelance interpreters) d. Overview of the history of healthcare interpreting in the United States e. The purpose and functions/responsibilities of the healthcare interpreter © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 11/37 f. Modes of interpreting in health care (consecutive, simultaneous, and sight translation) g. Media of interpreting (e.g., face to face or remote (telephonic or video)) h. Laws, standards, and regulations relevant to healthcare interpreting (e.g., Title VI of the 1964 Civil Rights Act [Section 601],1 Department of Health and Human Services [DHHS] Standards for Culturally and Linguistically Appropriate Services [CLAS],2 The Health Insurance Portability and Accountability Act of 1996 [HIPAA],3 The Joint Commission,4 the Americans with Disability Act,5 and relevant state laws and local policies). i. Liability insurance (e.g., Errors and Omissions) j. Availability, purpose, and limitations of certification 2. Language and communication: A basic program of study introduces the student to different aspects of language and communication dynamics as they impact interpreting. a. Language elements (e.g., regional and social dialects, style, register, and discourse; literal and figurative language; use of idioms and frozen language; literalness vs. meaning accuracy; paraphrasing; and conversation vs. interviewing) b. Communication elements (e.g., power dynamics and negotiation of meaning) c. Cultural elements of language (e.g., forms of address, politeness markers, turntaking and interruptions, and body language) 3. Professional practice: A basic program of study introduces the student to ethics in the healthcare profession as well as the ethical principles and standards of professional interpreter practice. 1 2 3 4 5 Information on Title VI can be found at Limited English Proficiency, A Federal Interagency Website, http://www.lep.gov/. Information on the CLAS standards is found on the Office of Minority Health website at http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15. Information on HIPPA can be found on the Health and Human Services website at http://www.hhs.gov/ocr/privacy/ Information on The Joint Commission can be found at www.jointcommission.org. Information on language access for the deaf/hard of hearing is available at http://www.ada.gov/reachingout/hospcombr(lesson2).html. © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 12/37 a. The general concept of ethics and its application to interpreting in health care b. Ethical principles and standards of practice consistent with the National Code of Ethics6,7 and National Standards of Practice for Interpreters in Health Care8 c. Self-care (including physical safety and emotional well-being and preparing for high-stress situations) 4. Health system: A basic program of study introduces the student to the key concepts, beliefs, and common terms relevant to the U.S. healthcare system. a. Overview of the U.S. healthcare system (e.g., venues, insurance, primary and specialty care, types of hospital services, categories of healthcare workers, and legal concepts and terms) b. Concepts and relevant terminology in biomedicine (e.g., anatomy and physiology, symptoms, common diseases, diagnostic procedures, common medications, treatments, and apparatus) c. Overview of common healthcare interview routines and medical decision-making (e.g., the medical interview, process of diagnosis, referral process, and physical exam) 5. Culture: A basic program of study introduces the student to culture and its impact on health and health care. a. Overview of culture—what it is and how it impacts health and health care b. Concepts and relevant terminology from the patient’s perspective (e.g., understanding of the human body and its functioning, descriptions of symptoms, common diseases and treatments, expectations around insurance, origins of illness, and complementary and alternative medicine) 6 7 8 National Council on Interpreting in Health Care. (2004). A National Code of Ethics for Interpreters in Health Care. Working Papers Series, July. http://data.memberclicks.com/site/ncihc/NCIHC%20National%20Code%20of%20Ethics.pdf Other comparable ethical standards have been developed by the California Healthcare Interpreting Association (CHIA) (http://www.chiaonline.org/) and the International Medical Interpreters Association (IMIA) (http://www.imiaweb.org/default.asp). National Council on Interpreting in Health Care. (2005). National Standards of Practice for Interpreters in Health Care. September. http://data.memberclicks.com/site/ncihc/NCIHC%20National%20Standards%20of%20Practice.pdf © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 13/37 c. The culture of biomedicine (e.g., the biomedical view of origins of illness, doctorpatient relationships, hierarchies, and decision-making) d. Cultural awareness and sensitivity 6. Resources: A basic program of study introduces the student to where to find and how to manage resources for further study for both knowledge and skill areas. B. Interpreting Skills: A basic program of study provides the student with models of effective practice and opportunities to develop the foundational skills of healthcare interpreting 1. Message conversion: A basic program of study gives the student opportunities to practice converting messages accurately and completely from a source language to a target language and includes the following components. a. Active listening b. Message (discourse) analysis c. Target language equivalence (e.g., figurative language, expletives, idioms, and colloquialisms) d. Managing regional dialects e. Maintaining / changing register f. Memory skills (e.g., chunking, prediction, visualization, and note-taking) g. Self monitoring and self-assessment 2. Modes of interpreting: A basic program of study demonstrates and gives the student practice in the various modes of interpreting. It focuses on developing consecutive interpreting skills as the default mode used in healthcare interpreting. a. Consecutive b. Simultaneous (exposure to) c. Sight translation9 9 A discussion of sight translation is included in National Council on Interpreting in Health Care. (2010). Sight Translation and Written Translation: Guidelines for Healthcare Interpreters, March. http://data.memberclicks.com/site/ncihc/Translation%20Guidelines%20for%20Interpreters%20REVISE D%2031710.pdf. © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 14/37 3. Interpreting protocols: A basic program of study demonstrates and gives the student practice in interpreting protocols based on understanding the rationale for these protocols and their appropriate use. a. Introducing and explaining the role of the interpreter b. Use of the first person c. Positioning,10 including the dynamics of different positions d. Conducting a pre-session or session introduction and post-session e. Intervention techniques (e.g., speaking as the interpreter in the third person and maintaining transparency) f. Managing the flow of communication g. Monitoring comprehension among listeners h. Interpreting for groups (e.g., team and family conferences and teaching sessions) i. Interpersonal skills (e.g., how to work with healthcare professionals, dealing with disrespectful providers or difficult patients, and de-escalating conflict) 4. Cultural brokering: A basic program of study demonstrates and gives the student opportunities to develop skills for mediating cultural differences. a. Recognition and management of cultural conflicts and misunderstandings b. Ability to recognize the interpreter’s own cultural biases and maintain objectivity in the interpreting encounter 5. Decision-making: A basic program of study gives the student opportunities to explore ethical and other professional dilemmas and situations. a. Ethical decision-making—The ability to think through an ethical dilemma and make an informed choice based on the National Code of Ethics for Interpreters in Health Care.11 10 Information on positioning is found at National Council on Interpreting in Health Care. (2003). Guide to Interpreter Positioning in Health Care Settings. November. http://data.memberclicks.com/site/ncihc/NCIHC%20Working%20Paper%20%20Guide%20to%20Interpreter%20Positioning%20in%20Health%20Care%20Settings.pdf. 11 National Council on Interpreting in Health Care. (2004). A National Code of Ethics for Interpreters in Health Care. Working Papers Series, July. http://data.memberclicks.com/site/ncihc/NCIHC%20National%20Code%20of%20Ethics.pdf © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 15/37 b. Critical thinking—The ability to think through a situation and make an informed choice about the best course of action to take and to justify this action 6. Translation in the interpreting context: A basic program of study teaches the student basic skills in on-the-spot translation and transcription of simple oral and written instructions. a. Ability to decide when on-the-spot translation or transcription is appropriate b. Ability to respond to requests for translations/transcriptions ethically and professionally © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 16/37 II. Instructional Methods Standards Introduction Effective training of interpreters requires an understanding of the key principles of adult learning and appropriate methods for helping candidates develop the knowledge and skills required by this field. When training adult learners, it is important to select appropriate instructional methods. Adults are not ―blank slates.‖ They come to training with knowledge and life experiences that affect how they understand health and health care, culture, and the work of interpreting. Eliciting existing knowledge gives the student a framework for incorporating new concepts, ideas, and skills. In addition, misconceptions may need to be corrected and assumptions based on limited experience may need to be challenged. Adults will have developed learning styles that vary from individual to individual. Some learn better by hearing, others by watching, and others by reading. Generally speaking, teaching methods that engage the learner in an active exchange with the material will be more successful. Skill-building is a particularly important part of interpreter training. Interpreting is not something one learns simply by reading or watching. Learners need to practice the skills, receive feedback, learn from their mistakes, and continue the cycle in order to develop and improve. As part of this cycle, interpreter trainers have come to appreciate the importance of a practicum— that is, an opportunity for student interpreters to observe professional interpreters in the workplace and provide real-life interpreting services while being observed themselves. Practicum programs are challenging to set up and supervise, and feedback from the field has underscored the difficulties that many programs of study encounter in trying to create practicum opportunities for their students. However, no classroom experience can, by itself, adequately prepare interpreters for the real-life challenges of interpreting in the wide variety of settings that constitute the healthcare system. The one-on-one supervision provided through a well-run practicum is invaluable in helping students adapt their classroom learning to the real world. For this reason, the standards strongly recommend that training programs include a practicum. © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 17/37 Adults typically lead busy lives with many responsibilities outside the classroom; they bring to training a lifetime of experience and specific learning goals, all of which must be considered and addressed if the educational experience is to be successful. Choosing appropriate teaching methods that make learning achievable, interesting, and immediately applicable to real life will maximize the success of that experience. This section, then, deals with standards related to teaching methods and includes best practices informed by the field of adult education and based on the insights of successful trainers. Instructional Methods Standards A. Interactive methods: Instruction is based on interactive techniques that engage students in ways that challenge them to internalize the content and develop the skills required of an interpreter. B. Guided practice: Instruction dedicates a significant amount of time to guided practice, gives students directed feedback, and monitors their skill development (especially in message conversion). C. Student learning needs: Instructional methods accommodate different learning styles and the knowledge and skills students bring with them. D. Varied teaching methods: A variety of appropriate teaching methods are used, including the following. 1. Presentation methods Examples: a. Lectures using visual aids and opportunities for interaction b. Readings, references, and links to resources c. Guest presenters, such as practitioners or working interpreters d. Student presentations e. Instructor modeling of effective practice f. Video, film, and vignettes to demonstrate real practice g. Storytelling providing real world situations © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 18/37 2. Skill-building exercises (for conversion accuracy) Examples: a. Parroting in the same language (for close listening) b. Paraphrasing (in the same language) c. Message analysis exercises (based on the source utterance) d. Message conversion exercises (unidirectional and bidirectional consecutive interpreting) e. Error analysis f. Prediction skills g. Memory exercises h. Note-taking exercises i. Terminology-building exercises 3. Guided practice of consecutive dialogue interpreting Examples: a. Behavior rehearsal through role plays—scripted and unscripted, progressive b. Simulations with invited practitioners or standardized patients c. Supervised practicum (also referred to as internship) d. Video/audio self-recording (pairs or individuals) and review 4. Critical thinking analysis for decision-making Examples: a. Case studies b. Application of code of ethics to ethical dilemmas/scenarios c. Guided discussions d. Sharing of experiences brought by students 5. Structured feedback Examples: a. Instructor to trainee: in class or practicum b. Peer to peer © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 19/37 c. Self-evaluation (self-reflective evaluation process, journaling, or audio recording with transcription and error analysis) d. Coaching (in person or remotely) by both the instructor and an interpreting coach who speaks the students’ language pairs. e. Back interpreting or use of a language coach for languages for which there is no interpreting coach f. Formative and final assessment. 6. Self-directed study Examples: a. Development of personal glossaries b. Language conversion practice c. Homework assignments i. Report on self-critique of performance or error analysis ii. Observational reports d. Readings (on patient culture, interpreter experiences, etc.) 7. Observation followed by discussion Examples: a. Videos b. Audio recordings c. Shadowing d. Field trips, such as a visit to a hospital 8. Practicum a. A supervised practicum is highly recommended to be an integral part of the program of study. The experience will provide the student with the opportunity to observe working interpreters, be observed, and receive feedback from a supervisor/mentor while carrying out professional responsibilities under appropriate supervision. b. To ensure that academic concepts continue to be applied, the practicum will be completed shortly after completing the training program. The time frame © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 20/37 for completing a practicum may be longer for speakers of languages of lesser diffusion. c. The practicum will be conducted in settings where principles learned in the program of study and appropriate to the learning needs of the student can be applied. © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 21/37 III. Programmatic Standards Introduction The programmatic standards are intended to identify common desirable features in setting up and administering training programs. They include standards related to operational policy, program design, student entry requirements, instructor qualifications, and student assessment. They emphasize the importance of having a well-designed curriculum that is planned in advance in consultation with appropriate specialists and utilized by instructors. By curriculum, we mean a general description of the program of instruction: learning objectives, content, sequencing, methods of instruction, teaching materials, activities, assignments, resources, and evaluation methods. The syllabus made available to students at the beginning of the course will provide an outline of the curriculum so that the students will know what to expect. A curriculum usually encompasses a series of courses, while a syllabus is specific to a single course or component of the curriculum. While these programmatic standards can be applied to any course or course of study, we recognize that training is offered under circumstances that vary greatly from program to program. Clearly, staffing will be handled differently in a community college than in a hospitalbased program, and a hospital might have different entry standards for candidates than a university. Because training contexts will vary, these programmatic standards should be implemented with a degree of flexibility to accommodate the circumstances of the training organization, the available resources, and the needs of the prospective learners. Programmatic Standards A. Operational Policies: Programs operate in an open and transparent manner. 1. A program’s description, publications, announcements, and advertising accurately reflect the program of study offered, including information on the following: a. Application process b. Admission requirements and methods of assessment c. Training or course syllabi d. Criteria for successful completion and methods of assessment © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 22/37 e. Type of certificate or other credential provided f. Tuition and fees g. Withdrawal and refund policies h. Other policies covering such areas as retakes of the final assessment and testout options for specific content areas i. Instructor/teaching team qualifications j. Organizational affiliation 2. A program provides opportunities for prospective students to find out about the program through direct communication (e.g., orientation sessions and pre-program communications). 3. A program maintains records that are accessible to students for a minimum period of 3 years, including the following: a. Attendance and enrollment status b. Grades and assessments c. Type of certificate or credential received 4. A program has an ongoing system for evaluating the effectiveness of its program of study and making improvements based on the evaluation results (e.g., assessment results, student feedback, teaching team debriefs, and feedback from employers of the program’s ―graduates‖). B. Program Design: Programs have an explicit and documented program of study. 1. The program design a. identifies the goals and learning objectives that the program of study covers, consistent with the knowledge and skills outlined in ―Section II: Program Content Standards,‖ and the National Code of Ethics and Standards of Practice for Interpreters in Health Care; b. provides a scope and sequence of instruction that will meet the program’s goals and learning objectives; c. integrates background knowledge, theory, skill development, and assessment; d. provides a student-to-teacher ratio that will facilitate the achievement of the stated program goals and learning objectives; e. provides students with ready access to course materials; and © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 23/37 f. is based on sound pedagogy and research on the acquisition of the required knowledge and skills. 2. Each course or training in the program of study has a written description that includes a. learning objectives; b. content covered; c. instructional methods used; d. training materials; e. expectations of students (e.g., attendance and assignments outside training or course time); f. assessment criteria (language proficiency, knowledge, and skills); and g. resources for further study for both knowledge and skill areas. 3. Practice and reference materials are available in the working languages of the students where feasible. 4. Whenever possible, a program of study includes a practicum/internship. When a practicum is provided, it a. is supervised by qualified personnel, b. is scheduled and completed within a time frame that ensures the transfer of classroom learning to application in the field/real world, c. is conducted in settings conducive to applying the principles learned through the program of study, d. is appropriate to each student’s learning needs and levels of proficiency, and e. provides a formal evaluation documented by the practicum supervisor and shared with the student. C. Entry Requirements / Screening: Programs screen applicants prior to admission to maximize the likelihood that they will be able to successfully complete the program. Entry requirements include the following: 1. Students are at least 18 years of age. 2. Students have, at a minimum, a high school diploma, GED, or country-of-origin high school equivalent. © 2011 National Council on Interpreting in Health Care, Inc., All Rights Reserved. The NCIHC National Standards for Healthcare Interpreter Training Programs may be reproduced as is in their current format under the copyright law of fair use. No changes may be made to the document except by the National Council on Interpreting in Health Care. Persons seeking to use this document should contact NCIHC. 24/37 3. Students demonstrate a level of oral proficiency in their working languages that enable them to develop linguistic conversion skills that maintain the meaning of the message accurately and completely (equivalent to ILR12 Level 3 or ACTFL13 scale Advanced High). 4. Students are literate in their working languages, with the exception of those languages in which the written form is not in common use. 5. Students have had life experiences in countries or cultural communities in which they communicated regularly in their working languages. D. Instructor Qualifications: Individual instructors or teaching teams collectively have the academic and experiential qualifications and professional background needed to meet program goals and objectives. 1. At least one member of the teaching team, pre