July 2007

Interpreters have been a social necessity throughout the ages. Sacajawea, the Shoshone Indian guide hired as interpreter and negotiator for explorers Lewis and Clark, is well known for her role in early American history. Today, immigration and migration trends spark demand for community interpreters; the need is especially great in courts, health facilities and other public institutions, as well as among businesses catering to these populations. The demand for interpreting is not only great in the U.S., but worldwide. According to latest edition of annual Trends in International Migration, member countries of Organisation for Economic Co-operation and Development (OECD) are experiencing record growth of newcomers seeking jobs or joining family. The current immigration trend began in the mid-1990s, and impacted countries are responding differently. While federal mandates have existed for over 40 years regarding the provision of interpreter services, the U.S. response is almost non-existent.

Australia, meanwhile, leads the way with a national approach to interpreting and translation services, together referred to as language services. Translation and Interpreting Service (TIS), a federal agency created by Australia’s Department of Immigration and Multicultural Affairs is one of several government-run language agencies in the country. Formalized in 1973, TIS initially facilitated communication for immigration and naturalization services for new, non-English speaking arrivals and provided emergency interpreting service. Soon, other government agencies and community services pressed for routine access to these federally funded resources. It was not until 1991 that the service became known as TIS. In 1998, a federal framework for the delivery of culturally responsive government services was enacted. The Charter of Public Service in a Culturally Diverse Society promotes proactive planning across all levels of government for the integration of new arrivals. The Charter’s seven principles to guide planning and service delivery were adopted by TIS and endorsed by federal, state and territories and the association of local governments. These principles focus on access, equity, communication, responsiveness, effectiveness, efficiency, and accountability.

Today, TIS offers interpreting and translation services throughout the Commonwealth of Australia. The agency works with more than 1,500 interpreters, who can be reached through a national call center located in Melbourne using a standard 1-800 number. Daily, interpreters speaking over 120 languages and dialects report their availability to accept assignments from their home computers. Interpreters can use cell phone, land line or computer to provide services. By simply calling the number and providing their PIN number, clients—including federal, state, local government offices, hospitals, doctors and businesses—can be connected within seconds to an interpreter who speaks their language. TIS call center operators simply ask what language is needed to call up a list of interpreters currently signed on to the system. The generated list provides a mini profile of all interpreters of the language requested, including their certification, training and interpreting experience. The operator matches the interpreter qualifications and confirms interpreter acceptance of the assignment before connecting parties. [Read more about Australia’s interpreter accrediting program below. ]

In less than one minute, call center staff connect a client to the appropriate interpreter. When the connection is made, the operator is no longer able to hear the conversation taking place. The call remains active on the system until terminated by either party; enabling an invoice with charges to be issued to the client and recording payment due to the interpreter. TIS staff report that nearly 60% of calls are from business professionals, realtors, car dealers, banks, credit card vendors transacting business with populations who speak limited English.

TIS services became fee-based in 1983; doctors and specialists in private practice can obtain interpreters at no cost for services provided to patients covered under Australia’s national health care system. This includes public hospitals, medical practitioners, optometrists or dentists financed through a progressive income tax and an income-related levy. Additionally, since 2000, PIN numbers issued to health providers enable call center staff to offer priority response to medical providers enrolled with TIS. In addition to on-demand interpreter services, TIS makes arrangements for “pre-booked” or scheduled telephone interpreter appointments and can arrange for in-person interpreting as well.

Australia and the U.S. have vastly different cultures and health care systems. Some may argue that a nationalized health system offers natural opportunities and resources to address language services nationally. These are important structural differences that merit further exploration. Still, the fundamental issue remains: the current ad hoc approach to languages services in the U.S. works against health care organizations and patients. Today, every health care organization in America is left to invent their capacity to meet federal mandates and clinical standards for a growing number of limited English patients. At a minimum, this is a waste of resources. It is in the interest of health care organizations to leverage efficiencies and economies of scale by centralizing, either nationally or regionally, interpreter resources and using internet and video conferencing or other technology for the provision of language services.

* Converted to US currency – See Conversion Column

The U.S. lacks national standards for health interpreters and tools to assess language or interpreting proficiency. The result: health care organizations often don’t know the difference between good, bad and high-quality interpreting and translation. Organizations who commission interpreting and translation services might as well be burning money in an effort to meet federal requirements around language services for limited English patients. Creating national standards in efforts to test and accredit translators and interpreters is a logical step in mapping out a coordinated language services strategy for the health industry. Australia recently created such standards only a few years ago, decades after it started a national structure for language services.

Within five years of launching Translation and Interpreting Service (TIS), the oldest and now largest government-run language agency in Australia, the need to establish standards for interpreters was recognized. The Commonwealth, State and Territory Governments of Australia established National Accreditation Authority for Translators and Interpreters, LTD (NAATI) as a national standards body to test and accredit translators and interpreters. NAATI, soon to celebrate its 30 year anniversary, serves as an advisory body for the translation and interpreting industry in Australia, providing advice and consultancy services on standards, accreditation, role and conduct of translators and interpreters, along with the skills required in various settings. It is also the accreditation body of first resort for new emerging languages, and is charged with creating methods to train and assess the skills of interpreters of less frequently used languages. NAATI has developed proficiency exams for 60 of the languages spoken in Australia, conducts training and offers testing throughout the country. [Click here to find out more about NAATI]

Announcements

American Public Health Association's (APHA)
Public Health Fellowship in Government

This fellowship will offer a public health professional the opportunity to spend one year working in Washington, D.C., on legislative, regulatory and policy issues that would benefit from the input of someone with public health expertise. The fellowship will begin in January 2008 and continue through December 2008 and is designed to provide a unique public policy learning experience, to demonstrate the value of science-government interaction, and to make practical contributions to enhancing public health science and practical knowledge in government.

APHA leaders and policy experts will review the applications and select the finalists through an open competition. The application is due to APHA by July 20, 2007 and selections will be made by September 30, 2007. All candidates must have a MPH or a Doctorate in a public health discipline. To learn more click here.

Medicaid and SCHIP Reimbursement Models for Language Services

Federal reimbursement for language services exist through the Centers for Medicare and Medicaid Services, however only a few states are taking advantage of this opportunity. All states receive at least 50% of incurred costs and some states are able to receive reimbursement as high as 79% of costs. There are currently twelve states plus the District of Columbia that currently provides reimbursement for language services. This report provides an overview of which states are taking advantage of this reimbursement opportunity for the provision of language services through Medicaid and SCHIP and outlines participant eligibility criteria, which providers can submit for reimbursement, who the State will reimburse and more. Does your state participate in this program? Learn more.

Medicare Prescription Drug Plans Fail
Limited English Proficient Beneficiaries

The National Senior Citizens Law Center (NSCLC) and partner organizations looked at health plan language service provisions for members with language barriers and found that more than 60% of limited English proficient callers to Medicare Prescription Drug Plans were not connected with an individual speaking their language and more than 50% of all calls ended without any attempt by the plan representative to connect the caller to someone speaking the caller's language. Health plans have an obligation to comply with Title VI of the Civil Rights Act of 1964 and many are struggling to provide language access services for their beneficiaries. NSCLC calls for detailed plans with comprehensive strategies for providing services to LEP individuals; monitoring of organizational compliance with federal requirements; providing customer service and language assistance training and ongoing oversight of contracted and in-house interpreters to ensure knowledge of health systems concepts and terminology and more. To read the report click here.

“HOW I LEARNED ENGLISH:
55 Accomplished Latinos Recall Lessons in Language and Life”

As the national debate about language and immigration continues, Tom Miller has compiled the personal life experiences of 55 Latinos learning to speak English. Personal accounts from authors, poets, playwrights, academics, entertainers, business leaders, scientists, athletes and politicians show the challenges and day to day struggles of living in the US and having limited English proficiency. All share a mixture of experiences – good and bad - about how easy or difficult it was for them to learn English, where they learned it and who they learned it from. ISBN 978-4262-0097-7 "Como Aprendí Inglés," a Spanish-language edition of the book, will be available Sept. 8.

Hablamos Juntos II – Language Policy and Practice in Health Care funded by the Robert Wood Johnson Foundation to disseminate lessons learned from ten demonstration sites around the country and to set standards and create practical tools for developing useful health materials in languages other than English.

More on Hablamos Juntos...