CLAS Standard 7: “Ensure the competence of individuals providing language assistance”
The Cultural and Linguistic Appropriate Services Standards published by the Office of Minority Health, US Department of Health and Human Services in April of 2013, are closely followed by many hospitals.
These standards have been written to reduce health inequities. Projections show that in 2050 the US demographic will be 29% Hispanic, 9% Asian. Currently, approximately 20% of the US population speak a language other than English at home.
As interpreters, we are part of the solution. Standard 7 focuses on the competence of individuals providing language assistance.
The skills mentioned in Standard 7 are critical. As I teach them to interpreters and I explain them to clients, these are my thoughts.
Active listening skills
Interpreters listen more attentively than anyone else in the room. A normal listener can get distracted and ask for a repetition. A speaker can decide to change the message as they speak. An interpreter, however, must be faithful to the message rendered. When we ask for a repetition, the second utterance is almost never identical to the one we heard the first time.
Often, note-taking helps interpreters listen more attentively. However, the notes could have confidential information. That is why I always leave my notes with the provider at the end of the session, so they can be processed per HIPAA standards. If I accidentally bring the notes home, I shred them as soon as possible. In any event, those notes are torn out of the notebook immediately so they are not in the notebook when I go to the next assignment.
To listen attentively, interpreters need an environment in which they can hear every detail clearly. Line of sight with the speaker, for example, is very helpful. Being able to sit in a place where the audible or visual distractions between the speaker and the interpreter are minimized enhances our ability to listen attentively. Because interpreters are the ones who understand their needs, they must courteously advocate for conditions that allow them to provide the needed language assistance.
Message conversion skills
As a friend of mine puts it, “Meanings have words.” So, we have to find the words, phrases, sentences, that match those meanings.
The message is more than just the words used. Many non-interpreters understand the importance of knowing terminology. However, terminology is only part of the issue. Words are used in context, and the discourse of medical topics in a doctor’s office is different from a conversation about our health in a living room. Lack of familiarity with the discourse is often a more significant barrier to communication than the terminology issues themselves.
Besides, each language has a different way of expressing similar concepts. Translators and interpreters should be able to speak and write in the target language without sounding like “English with Spanish words” or “Spanish with English words”. Interpreters must be faithful to the message, not to the words in the message. Interpreters must understand that they can simply restate the message they heard without being too closely tied to the specific words used in the source language. This understanding releases them to interpret more accurately, in a way that is more easily understood by the listener.
Working knowledge of anatomy and physiology
Extensive knowledge of the vocabulary and terminology related to diagnosis, prevention, treatment, and management of illness and disease
Command of the vocabulary related to the provision of health care in both languages
Subjects like anatomy, physiology, etc. can be taught in a classroom setting. Because of privacy concerns, interpreters often do not know what the interpreted session will be about until the session starts. Because of the nature of being on call, they may not know what specialties they will be dealing with in a given day. Therefore, interpreters should have the skills and resources to quickly review the issues of that specialty in the few minutes they have in the waiting room before the session starts. With the apps available on today’s phones, this is feasible.
The apps available today are equivalent to carrying a lot of books! See an article about my favorites in this blog post.
Clear and understandable speech delivery
Interpreters work in noisy environments, and they people they interpret for are distracted by many things. The interpreter’s speech should be clear enough that the listener does not have to strain to understand it. Speech delivery that is not “clear and understandable”, as CLAS aptly states, leads to less efficient comprehension of the message delivered. Personally, I work on this by taking voice lessons. My voice teacher helps me keep a clear voice and project in a healthy way, so I can be heard in many settings.
Familiarity with regionalisms and slang in both languages
Ability to identify differences in meaning due to dialects or regionalisms to ensure effective and accurate message conversion
Understanding of colloquialisms and idiomatic expressions in all working languages
Slang varies very widely between regions, countries, and social groups, even among monolingual English speakers in the United States. The interpreter should be able to identify situations in which the use of slang affects the meaning, in order to ask for clarification as needed. Though interpreters will continually learn new terms and new slang, nobody can interpret what they cannot understand. Therefore, they should ask for clarification.
Ability to communicate in all registers and at varying levels of formality
LEP members of our community have a broad diversity in backgrounds. In their countries of origin, some are professionals, others are manual laborers, some are teachers, and others are not schooled. Interpreters need to be able to communicate in all levels of formality to be able to reach all LEP members of our community effectively.
Understanding of key concepts in health care, such as confidentiality, informed consent, and patients’ rights
Interpreters must be familiar with the basic ethics of health care in the United States. However, they must also understand that these concepts are new to the patients with whom they work. In many cases, patients do not understand that they have a right to be listened to, that the opinion of the patient is important to the provider, that “confidentiality” means that the doctor will not reveal any information to anyone without the specific authorization of the patient, etc. Being alert to these differences in expectations and understanding may help interpreters encourage providers to explain these concepts to their patients.