|
|
Workshops
| A
| B
| C
| D
| E
|
Workshop
E-3: Interpreter services: a dialogue with the managers of mature programs
Peer-to-peer practice advancement session
The goal of peer-to-peer practice advancement sessions is to allow professional
peers the opportunity to discuss, before an audience, issues of common
concern as a way of advancing the state of practice in their respective
fields. These two-hour sessions will have 5-7 featured experts who will
be led in a discussion of key issues related to the theme of the session.
Speakers will not make formal presentations, but instead provide critical
details of their programs to each other and to the audience in 2-page
handouts. During the session, each expert will concisely address specific
questions or topics developed and distributed in advance before engaging
in a moderated discussion with each other. The last half hour will be
reserved for audience Q&A
This session will focus on issues related to running, improving and
sustaining interpreter services programs, as experienced by the managers
of mature programs from around the country. This particular session was
inspired in part the Massachusetts-based Forum of Coordinators of Interpreter
Services (FOCIS), a support forum that meets regularly to discuss
these topics. The discussion during this workshop session will evolve
from the following stage-setting questions:
- What are the unique strengths of your interpreter service program?
How were they developed, and how might they be replicated in other programs?
- What are the three most challenging issues faced by your interpreter
service program? How are you dealing with these issues, and what resources
or support would enable you to resolve them?
- How can some of these issues be addressed at the policy level—both
institutional and national?
Other topics that may be explored include:
- Interpreter competency, training, and certification
- Under/inappropriate utilization of interpreter services (staff awareness,
patient preference, quality of services, institutional policies that
discourage utilization)
- Fiscal constraints that drive institutions towards remote interpreting
or overall service cutbacks
- Program reorganization and refocusing
- Integrating IS with cultural competence initiatives
- Cultural competence of interpreters and other staff
- Racism
- Using free-lancers, contract services (cost, qualifications, reliability)
- Recognition by administration and staff of interpreter value, responsibilities,
needs
The participants for this session are:
Oscar Arocha Director, Interpreter Services
Department, Boston Medical Center, Boston, Massachusetts
Shiva Bidar-Sielaff, MA Manager of Interpreter
Services, University of Wisconsin Hospitals & Clinics, Madison, Wisconsin
Carla Fogaren, RN Principal Facilitator,
Forum of Coordinators: Interpreter Services (FOCIS), Milton Village, Massachusetts
Boris Kalanj, MSW Director, Interpreter Services
and Cultural Care, Children's Hospital and Clinics, Minneapolis, Minnesota
Martine Pierre-Louis, MPH, Manager, Interpreter
Services & Community House Calls, Harborview Medical Center, Seattle,
Washington
Moderator: Loretta Saint-Louis Director
of Interpreter Services, Cambridge Health Alliance, Somerville, Massachusetts
Participant abstracts and bios can be found on the pages that follow.
Oscar Arocha, Director, Interpreter Services Department
& Guest Support Services, Boston Medical Center, Boston, Massachusetts
In 1996, Boston City Hospital and Boston University Hospital merged
to become Boston Medical Center. One public entity, and one private one,
created the largest safety net hospital in New England. The fusion of
these two distinct cultures had a goal clearly defined on its mission
statement “We will provide consistently excellent accessible health
services to all in need of care regardless of status and ability to pay”.
Today, BMC is a private, not-for-profit academic medical center with 547
licensed beds. It is the primary teaching affiliate for Boston University
School of Medicine. It is the largest safety net hospital and the largest
24-hour Level I trauma center in New England. It has more than 27,500
admissions and over 854,000 patient visits annually. Last year BMC provided
approximately $306 million in free care to uninsured populations.
Today, communities around the Boston Medical Center have diversified
to an extent never imagined a few years ago. Somali, Kurd, Polish, Bosnian,
Brazilian, Albanian, Vietnamese, Cape Verdean, and the Chinese surrounding
communities now have full time interpreters available to them at BMC.
With a budget of 2.3 million, the current interpreter program of 2004
is able to provide interpreters for over 130,000 requests per year. The
interpreter staff is comprised of 30 full-time medical interpreters, 18
per diem interpreters, and 20 contractors. Additional telephonic and video
interpreting services are provided under contract with several out of
state agencies. Administrative staff includes 4 scheduling assistants,
an administrative assistant, a schedule supervisor, an on-call supervisor,
a staff coordinator, a training coordinator, a manager, and the director
(see org. chart).
Reporting to the Chief Operating Officer after a merger, was in my opinion,
the best strategic position for a department that needed to grow. This
reporting structure was key to quick implementation measures that allowed
the department to expand and gain credibility. New data was being gathered,
while policies and procedures, departmental regulations, job descriptions
and interpreter assessment tools were revised and/or created. As new statistical
data was being presented, we received approvals to add full time positions,
to move into new office space, and to launch a series of initiatives that
would rise the level of cultural competencies through out the organization.
These initiatives had the strong support of the CEO.
The Employee Diversity Council was created to advise the hospital on
cultural competency needs, and the Interpreter Services Department was
par of it. One of the main initiatives was the development of the Cultural
Forums. These forums were very successful as they gave a new perspective
and knowledge of each new community served at BMC. They were video taped,
and continue to be available for internal training to this date.
With this initiative, the need for partnership between the Interpreter
Service Department and other cultural competency efforts taking place
at BMC became obvious. However, the need to educate an entire institution
on the appropriate utilization of medical interpreters needed to be addressed
rapidly. Training was offered internally to our staff, and externally
to other departments. As a result, training partnerships were created,
and these continue to this date.
Training an institution to become culturally competent, is a task that
needs to be addressed from many angles. The following are some of the
strategies we were able to undertake:
- Creation of a multi-lingual paging service
- Direct interpreter telephone extension
- Language assessment cards
- Language ID badges
- Cross-campus tri-lingual signage
- Interpreter Services intranet site
- Down-loadable, multi-lingual translated versions of consents, discharge
teachings, and discharge instructions
- Video interpreting
- Cultural training programs for residents, nurses, hospital security,
unit coordinators, receptionists
- Introduction of the “Campus Usher”
- Contributions at the Patient Satisfaction Committee
- BMC’ Cultural Diversity Week
The latest strategic step made by the Interpreter Services Department
in assisting with the institutional initiatives on cultural competency,
was acquiring responsibilities for all reception and information desks
of the hospital, or the Guest Support Services, with an annual budget
of $800,000. Given that they are the first contact with all patient and
visitors, the new Interpreter & newly added Guest Support Services
began a series of initiatives to enhance the interaction with LEP patients
and visitors. We proceeded to redo the receptionist job descriptions,
and added many elements of multiculturalism. Mandatory training in “Cultural
Diversity”, “Culturally Appropriate Customer Service”,
and “Dealing with a Culturally Diverse Population”, became now
part of their annual training requirements. The hiring of the staff now
takes into account their linguistic and ethnic diversity as key elements
to their desired skills. The intent is for the reception staff to resemble
more to the communities the hospital is carrying for. Information desks
can now address language needs the moment the LEP person enters the hospital.
Language needs assessment is done at the first contact, and the LEP person
receives from the information desk a form that identifies the language
he/she speaks, and provides additional information on how to contact Interpreter
Services. Multilingual “Campus Ushers” were created to respond
to one of the most common challenges of every major hospital: the lost
patient/visitor.
A lengthier program description together with an organizational chart
is available in this year’s conference resource binder.
Mr. Arocha is an experienced health care administrator who has
had extensive experience in running Interpreter Services in Massachusetts.
His background involves having worked as a staff interpreter for Brigham
& Women’s Hospital, New England Medical Center and freelancing
for many hospitals in Massachusetts. In 1991, he founded Global Communications,
a translation agency in Boston that specialized in medical translations.
He became an active member of the Massachusetts Medical Interpreter Association,
and was the regional director for the Boston area for two consecutive
years. In 1995, he became the operations manager at New England Medical
Center's Interpreter Service. He was called in 1996 to head the Interpreter
Services at the newly merged Boston Medical Center. He has since developed
one the largest and most comprehensive Hospital-based Interpreter Services
program in the country, with a staff of over 38 FTEs, 20 per diems, and
numerous contractors, attending over 130,000 interpreted clinical encounters
per year. His eight-year tenure has allowed him to continuously develop
initiatives that have been replicated in other hospitals, in addition
to the recent integration with Guest Support Services. He was instrumental
in bringing one of the oldest college level educational interpreter program
of New England from Bentley College to Boston University, two years ago.
Mr. Arocha was born in Venezuela, is well traveled, and has actually lived
in Egypt, Italy, Spain, Iran, Japan, Austria, and Brazil. He is fluent
in French, Spanish and Portuguese.
Oscar Arocha
Director, Interpreter Services Department & Guest Support Services
Boston Medical Center
771 Albany Street
Dowling 4 South, Suite 4501
Boston, MA 02118-2393
Tel. 617-414-7204
Fax. 617-414-3324
Oscar.arocha@bmc.org
Shiva Bidar-Sielaff , MA Manager of Interpreter
Services, University of Wisconsin Hospitals & Clinics, Madison, Wisconsin
University of Wisconsin Hospital & Clinics (UWHC) is a health care
system consisting of a 471-bed hospital and large number outpatient clinics,
located in Madison, Wisconsin.
The UWHC Interpreter Services Department consists of 6 full-time staff
(Manager, interpreter scheduler and four Spanish interpreters) and over
120 free-lance interpreters. In Fiscal Year 2004, we provided interpreter
services for over 17,000 medical encounters, the majority of which were
outpatient clinic visits.
Operationally, some key elements that have contributed to the success
of our department have been:
- Our centralized scheduling system: all requests for interpreter services
come to our central scheduling number and interpreters are arranged
and dispatch by the interpreter scheduler.
- Our ability to capture language spoken by the patient in our patient
database. This allows us to receive daily automated reports that help
us schedule interpreters more efficiently.
- In 1995, we formed a coalition of health care providers to address
as a group the issue of language access to each of our institutions.
This coalition, the Dane County Health Care Providers Medical Interpreter
Program, consists of 10 members who represent all the major health care
institutions in our county. Through our collaborative approach we have
been able to ensure consistency in the provision of interpreter services
across our institutions, we have developed an interpreter initial assessment
tool, and we have created a local “language bank” of over
120 interpreters.
Shiva Bidar-Sielaff is the Manager of Interpreter Services and
Minority Community Relations at the University of Wisconsin Hospital &
Clinics. On a national level, Ms. Bidar-Sielaff has worked extensively
on issues of equal access to health care for limited English proficient
(LEP) individuals. She is the Co-chair of the Standards, Training and
Certification Committee of the National Council on Interpreting in Health
Care. Ms. Bidar-Sielaff is very involved in promoting equal access to
health care for LEP population in Dane County. Ms. Bidar-Sielaff is the
Vice-Chair of the Dane County Latino Health Council and an active member
of the Latino Support Network. In April 2000, she was awarded the Dane
County Public Health Leadership Award for Multicultural Health Care. Ms.
Bidar-Sielaff obtained her BA for the School of Interpreters, University
of Hainaut, in Mons, Belgium, and her MA from the Monterey Institute of
International Studies in Monterey, California
Shiva Bidar-Sielaff, M.A.
Manager of Interpreter Services and Minority Community Relations
University of Wisconsin Hospital & Clinics
600 Highland Ave Mail Code 2460
Madison, WI 53792
(608) 265-7424 (phone)
(608) 265-1704 (fax)
s.bidarsielaff@hosp.wisc.edu
Carla Fogaren, RN Principal Facilitator, Forum
of Coordinators: Interpreter Services (FOCIS), Milton Village, Massachusetts
Over 457,000 individuals reside in Caritas Good Samaritan Medical Center’s
(CGSMC) primary service area which encompasses the city of Brockton and
twenty-one surrounding communities, including: Easton, Norton, Stoughton,
Sharon, Canton, Avon, Holbrook, Randolph, Whitman, Abington, Rockland,
Hanson, Halifax, East Bridgewater, Bridgewater, West Bridgewater, Raynham,
Taunton, Berkley, Middleboro, and Lakeville. Our population is very diverse-economically,
racially, culturally, and linguistically. Our diversity includes Portuguese,
Cape Verdean, Latino/Hispanic, Haitian, Asian, African American, and White
individuals and families. Of our linguistic patients, 35% speak Portuguese
and most of these individuals are Brazilian, 19% speak Cape Verdean, 16%
speak Spanish, 15% speak Haitian Creole and the remainders speak a variety
of other languages including French, Vietnamese, Chinese, Greek, Russian,
Polish, Italian, and American Sign Language.
CGSMC started the Interpreter Services Department in 1993. However in
1997 we realized that we did not fit the traditional interpreter services
program. This community needed something additional. In order to stay
true to the Massachusetts Medical Intepreters Association’s Standards
of Practice we had to change the scope of service of the department. In
1997 the Interpreter Services Department expanded to become the Community
Outreach & Interpreter Services (COIS) Department. This would allow
CGSMC to assist non-English and limited-English speakers with other very
important issues outside of the interpreter arena. Non-English Speaking
patients were always seeking out the interpreters for issues outside of
the traditional medical interpreting role. Interpreters were requested
to assist patients with bills, phone calls, parent-teacher conferences
at school, insurance issues and often times asked to interpret for the
patients during doctor’s appointments outside of the hospital.
The unique strengths of this program are the collaboration between COIS,
other departments in the hospital and numerous community based agencies.
COIS provides medical interpretation, case management, education, outreach,
and referral services for non-English speaking patients at the hospital,
affiliated facilities and subject to availability, interpreters to affiliated
physician offices upon request from the patient. This allows for a wonderful
continuum of care that does not traditionally exist.
In this interactive session I will describe CGSMC’s experience
developing a Community Outreach and Interpreter Services Department. In
this era of budget constraints, hospitals are struggling to survive especially
in complying with unfunded mandates. But the consequences of not complying
are far too serious. Providing interpreter services still remains largely
an unfunded mandate. I will describe specific strategies and initiatives
that have resulted in the COIS Department being a revenue producing department.
In addition I will discuss the formation of the Forum of Coordinators
of Interpreter Services (FOCIS). Currently 45 hospitals are members of
FOCIS and we meet bimonthly to work collaboratively on issues related
to interpreter services. Issues considered include sharing resources and
methods, interviewing freelancers and challenges of managing an interpreter
services program. In the short time since our inception, we have done
a large amount of work. Among our most significant accomplishments is
the development of a Basic Standardized Interpreter Assessment Test to
be utilized by all FOCIS member organizations for assessing basic proficiency
of medical interpreters.
Many lessons were learned along the way. Lessons learned include the
importance of appropriately documenting interpreter encounters as well
as defining what constitutes an interpreter encounter. This is very important
in order to get potential reimbursement that may be available as well
as additional staffing and resources. Perhaps one of the most important
lessons learned was to strategically position the COIS Department within
the organization.
Carla Fogaren, RN is an experienced health care manager with
extensive experience in the areas of Interpreter Services development.
Ms. Fogaren’s background includes not only her work as a medical
interpreter but also her being an ardent advocate for the profession of
medical interpretation. Carla served as the Vice President of the Massachusetts
Medical Interpreters Association (MMIA) for three years and participated
in the working group that developed the MMIA Standards of Practice for
Interpreting. Carla has testified numerous times at the Massachusetts
State House about language access and interpreter services issues. Carla
was featured in an article published in a 2000 American Journal of Nursing;
"Cultural Competence: A Nursing Dialogue". She is the recipient
of the 2002 Health Care for All Award "People Against the Tide"
for her work in expanding access and quality of care in the community.
Carla was born in Angola, raised in South Africa and came to the U.S.
as a teenager. She is currently the Director of Community Outreach &
Interpreter Services at Caritas Good Samaritan Medical Center in Brockton,
Massachusetts. Additionally, Carla also works as a healthcare consultant
for CultureSmart where she provides health care consulting, needs assessments
around language access and training of medical interpreters.
Carla Fogaren R.N.
Director of Community Outreach & Interpreter Services
Caritas Good Samaritan Medical Center
235 North Pearl St, Brockton, MA 02301
Phone: 508-427-3570
Fax: 508-427-3645
Carla_Fogaren@cchcs.org
Boris Kalanj, MSW, Director, Cross Cultural Care
and Interpreter Services, Children’s Hospitals and Clinics, Minneapolis
and St. Paul, Minnesota
Children’s Hospitals and Clinics is the eight largest pediatric
health care organization in the United States. A not-for-profit health
care provider, the organization consists of 2 hospital campuses (299 staffed
beds) and several outpatient clinics. Located in center cities of Minneapolis
and St. Paul, Minnesota, Children’s serves an increasingly diverse
population. Each year, we provide care through over 13,000 inpatient visits
and more than 200,000 emergency room and other outpatient visits.
Children’s department of Cross Cultural Care and Interpreter Services
grew from what was originally (8 years ago) formed as a narrowly-defined
interpreter service into a broader-focused department concerned with all
aspects of organizational cultural competence. The department is charged
with boosting Children’s organizational capacity to give effective
care to our linguistically and culturally diverse patients. This work
is done through a three-prong approach: a) integration of linguistic and
cultural mediation services, b) development of a culturally competent
work force, and c) development of supportive policies, procedures and
management practices. These three areas form the axes of our Cross Cultural
Care Strategic Plan, which we developed as a blueprint for carrying out
this work within the organization. Our department’s budget is about
$1.1 million annually. Here is a more detailed look at the two main components
of our program:
Interpreter Services Component
In 2003 we provided interpretation for about 18,000 medical encounters.
Our most represented languages are Spanish (50%), Somali (20%) and Hmong
(15%). We have 9 full-time staff interpreters for Spanish, Somali and
Hmong, who accomplish about 50% of our patient volume. The rest is done
through contract and agency interpreters, as well as a smaller portion
through Language Line Services. Our other employees are two schedulers/program
assistants, interpreter/translation supervisor, manager of cross cultural
training and development, and program director.
We have a centralized interpreter scheduling telephone line (612-813-7600),
which is used 24 hours a day, 7 days a week. During the day hours, the
line is staffed by a scheduler. During evenings and weekends, callers
are prompted by the automated phone system to select the language that
they need, and then immediately connected to a cell phone held by an on-call
staff interpreter for Hmong, Somali or Spanish, or a scheduler for an
outside contracted agency for all other languages. Access to Language
Line is integrated into the phone system as the ultimate back-up option.
This centralization of all calls from all parts of our system - at all
times - to one number has allowed us to have greater insight into interpreter
needs, as well as ability to improve effectiveness and efficiency of our
service.
We recently built an interpreter-scheduling component within the larger
computerized patient scheduling system. We expect this to help increase
efficiency in interpreter deployment, as well as give us the ability to
get needed data reports on utilization patterns. The process of building
this system took an intensive collaboration with Children’s ITS department
and lasted over a year.
Our department is also charged with managing translation needs for the
organization, which is done through a combination of internal and external
resources. Of note is our membership in the Multilingual Health Resources
Exchange, a local consortium of health care organizations and health plans
aimed at sharing translated and multilingual materials relevant to patient
care. Materials developed by member organizations can be downloaded from
the Exchange database, which is linked to Children’s Culture and
Health web pages.
In Minnesota, outpatient interpreting for MA patients is generally reimbursable.
We started developing contracts with HMOs (PMAP plans) and developing
billing systems for recouping some of the expense of staff interpreters.
We found this process to be complicated to navigate for many reasons,
from lack of clarity in state guidelines that leave each HMO with their
own interpretation, to the complex web of billing pathways the organization
uses – none of which provided an easy fit for interpreter billing.
This is a work in progress.
Cross Cultural Care Component
Staff interpreters also function in a cultural mediation capacity. Several
of them actively participate as trainers of other staff on such topics
as working with interpreters and culturally-specific health care values
and practices of our commonly-encountered linguistic and cultural minority
groups. This is very important, as our organization’s mostly Caucasian
and monolingual staff members often do not have a keen natural understanding
of the complexity of human health care communication across languages
and cultures.
Our department has been instrumental in creating and facilitating a
training curriculum for new employees on the topics of diversity and cultural
competence. As part of Children’s new employee orientation, the 4-hour
training session was made a mandate for all new employees. In addition,
every new employee who will have contact with patients is required to
attend an additional provider orientation, as part of which our department
teaches a 1-hour session on working with interpreters.
Workforce education aimed at increasing cultural competency continues
beyond new employee orientation through an array of presentations and
workshops to various audiences, utilizing a combination of internal and
outside experts. As examples, we have held a 2-hour mandatory cultural
competency overview for all employed physicians and other professional
staff; organized an annual regional conference on the topic of cultural
competence in pediatrics; given presentations to the Board of Directors,
the Leadership Team and the Directors and Managers group; and offered
Grand Rounds sessions on using interpreters and resolving ethical dilemmas
in cross cultural health care.
We have developed, and actively maintain, an elaborate internal web
site on culture and health, dedicated to helping Children’s employees
work effectively in our multicultural and multilingual environment. The
web site emphasizes the synergy between language, culture, health, and
health care delivery while providing a wealth of information and an interactive
organizational forum for sharing questions, offering advice, and showcasing
best practices in the delivery of culturally competent care.
As an important part of Children’s efforts on building cultural
competence and reducing health disparities, our department has facilitated
collaborations between Children’s and various local community organizations
representing major linguistic and ethnic minority groups. Examples include
a joint project with Hmong National Organization on reducing access barriers
for Hmong children; developing a proposal for a Somali Health Information
Center in an ethnic indoor market geared at bolstering preventive pediatric
care in the local Somali community; producing multilingual health outreach
videos on benefits of immunizations and understanding the health care
system; and setting up a spiritual support network for non-Christian patients.
We made a purposeful effort to connect and integrate with the organization’s
long-standing Diversity Action Council, traditionally ran out of Human
Resources. One of the staff members from our department serves as the
Council’s facilitator.
We are also facilitating the organization’s efforts on collecting
more accurate and reliable demographic data on patient race/ethnicity,
primary language, need for interpreter, and religion. This is another
complex task, requiring great efforts on securing buy-in and compliance
from various internal partners, such as IT and Admissions.
I would – of course – be happy to share any of the resources
and material that was developed by our program upon request.
Boris Kalanj, MSW, LISW, is director of Cross Cultural Care and
Interpreter Services department at Children’s Hospitals and Clinics
in Minneapolis and St. Paul, Minnesota. He is charged with leading organizational
development toward such systems of care that can successfully meet the
special needs and overcome the special barriers experienced by linguistic
and other cultural minority patients. This includes provision of language
access services, workforce education, and building better data collection,
evaluation and research capacities related to access and quality of health
care for limited-English speaking patients and families. As a licensed
social worker grounded in the commitment to social justice and human rights,
throughout his career Boris has thrived on seeking ways to give voice
to the voiceless. Prior to his appointment at Children’s, he was
a staff social worker at the Center for Victims of Torture in Minneapolis.
Boris has experience working both as an interpreter for Bosnian refugees
in Minnesota and as a provider using interpreters in his communication
with clients. He has given numerous workshops for providers in health,
human services, and education fields on communication skills, working
with interpreters and other areas of cultural and linguistic competence.
Boris has a Master’s degree from the University of Minnesota, and
a B.A. degree from the University of Zagreb, Croatia.
Boris Kalanj, MSW
Director, Cross Cultural Care and Interpreter Services
Children’s Hospitals and Clinics
2525 Chicago Avenue South
Minneapolis, MN 55404
(612) 813-7989 (phone)
(612) 813-7633 (fax)
boris.kalanj@childrenshc.org(e-mail)
www.childrenshc.org
(website address)
Martine Pierre-Louis, MPH, Manager, Interpreter
Services & Community House Calls, Harborview Medical Center, Seattle,
Washington
Harborview Medical Center is a 368-bed patient care, teaching and research
facility located in Seattle, Washington. Harborview is owned by King County
and managed by the University of Washington. The medical center is a regional
referral center for trauma, burn and specialty care. In 2003, Harborview
had over 22,000 inpatient admissions; 88,000 emergency room and urgent
care visits; and 339,000 outpatient visits. Harborview is, by far, the
largest health-care provider of charity care in Washington State. In addition,
as a facility owned by King County, Harborview gives priority to a patient
population that includes: mentally ill patients, persons incarcerated
in the King County jail, victims of domestic violence and sexual assault,
non-English speaking poor, and indigents without third-party coverage.
The Interpreter Services department enables Harborview Medical
Center to provide equal access to care to limited-English proficient patients
(one of the Medical Center’s priority populations). Fifty-six employee
interpreters (thirty-one permanent and twenty-five hourly) provide interpretation
in thirty-two languages and dialects. Additional language coverage is
accessed through contracts with three agency language banks. For the past
three years, the most requested languages were Spanish, Somali and Vietnamese.
In 2003, over 100,000 hours of interpreting were provided during 93,000
encounters in 83 languages and dialects.
In December 2003, the department’s model changed from a contractor-based
to an employee-based interpreter model. This allowed us the opportunity
to establish standards of practice for Harborview and train our team of
interpreters to those standards. Since employee interpreters perform roughly
75% of medical interpreting in the Medical Center, we are able to guarantee
a certain level of quality, consistency and continuity of interpreting.
Having a stable team of employee interpreters has also allowed us to develop
a new focus on continuing education for medical interpreters. The current
emphasis of our continuing education is on the concept equivalence in
messages between two languages. In monthly sessions, the medical director
for our department has interpreters present challenging cases and brainstorm
appropriate solutions. Past sessions have focused on terms such as ‘risk’,
‘menopause’ and ‘impotence’ that are difficult to
transmit into equivalent terms conceptually and experientially across
cultures.
In July 2004, Interpreter Services increased its use of telephonic interpreting
as a resource for patient encounters that do not have an employee interpreter
assigned. Telephonic interpreting has been used at Harborview for the
past three years and, based on institutional experience, there is a strong
sense that this resource can work in patient encounters that meet specific
criteria. In anticipation of more widespread use of telephonic interpreting,
a team of medical interpreters and providers developed ‘Levels of
Interpreting’. The ‘Levels of Interpreting’ document prioritizes
face-to-face interpreting to clinical encounters identified as more complex
and/or sensitive. Over the coming year, this document will be revised
and refined This evolving system fits within our vision of developing
the capacity to address communication needs using an array of modalities
and technologies, each deployed as is appropriate for the task and setting.
The department’s long-range goals include piloting an in-house telephonic
resource (for greater sensitivity to local knowledge, patient community
and rapid response if face-to-face interpreting is required); growing
our catalogue of educational web-based tutorials, audio, video and print
translations; and increasing our capacity for interpreter and provider
education around linguistic and cultural issues in health care.
Community House Calls works to build bridges between Harborview
Medical Center and the immigrant communities we serve. The program uses
interpreter/ cultural mediators who function as outreach workers and case
managers, as well as facilitators of dialogue about social and health
issues between individual providers and their patients; and between the
Medical Center and six linguistic communities (Cambodian, Tigrigna, Spanish,
Somali, Amharic, and Vietnamese). In addition to facilitating access to
health services for patients from their linguistic and cultural communities,
interpreter/cultural mediators provide cultural mediation (facilitate
clinical encounters that involve cultural differences), cultural consultation
(consult about cultural issues affecting the care of a particular patient),
and provider education (on topics such as health beliefs, traditional
health practices, and explaining diagnoses to patients).
Our unique strengths:
- A community (Washington State) that is activated around quality health
care access for limited-English proficient persons and has been for
a long time. Some benefits of this are: state funds to reimburse medical
interpreting for Medicaid patients; a solid supply of certified (Department
of Social and Health Services) and trained (Bridging the Gap and other
local training) medical interpreters in many languages.
- The ten-year tenure of the Community House Calls program within the
institution has fostered the building of strong links with seven communities
in the area. These communities represent the largest language groups
within Harborview’s patient population.
- The keen interest, curiosity and strong support of Harborview’s
medical community has helped to generate some stellar efforts such as
Ethnomed, a website containing medical and cultural information about
immigrant and refugee groups. Ethnomed provides information about culture,
language, health, illness and community resources to health care providers
who see patients from different ethnic groups. Ethnomed’s development
team includes a medical librarian, a physician, an interpreter and members
of House Calls Community Advisory Board.
Our challenges:
- Though Harborview’s support for and commitment to Interpreter
Services & Community House Calls have been unwavering over the long
term, the institution’s current situation as a safety net provider
has severely taxed its resources. Like many others in public institutions,
the department is having to do more with fewer resources.
- Interpreter Services’ scheduling system is an on-going challenge.
We continue to struggle with sorting through multiple simultaneous needs
and determining how to best ensure that the most appropriate resource
(face-to-face VS telephonic) is assigned to each situation.
Martine Pierre-Louis manages Interpreter Services and Community House
Calls at Harborview Medical Center. A Haitian Creole and French interpreter
for over a decade, she is a founding member and past board member for both
the Society of Medical Interpreters (SOMI) and the National Council on Interpreting
in Health Care (NCIHC). She brings to her work a strong commitment to the
medical interpreting profession and years of experience managing community-based
public health efforts with a focus on access to health care and equity for
refugees and immigrants.
Martine holds a bachelor’s degree in sociology and math from Fordham
University, and a master’s degree in public health with a focus on
health services and international health issues from the University of
Washington.
Martine Pierre-Louis, MPH
Manager, Interpreter Services & Community House Calls
Harborview Medical Center
325 Ninth Avenue, Box 359977
PSB 3074
Seattle, WA 98104
Phone: (206) 744-9257
Fax: (206) 744-9981
martine@u.washington.edu
www.ethnomed.org
Facilitator:
Loretta Saint-Louis, Director of Interpreter Services, Cambridge
Health Alliance (Somerville, Massachusetts)
Loretta Saint-Louis, Ph.D., is the Director of the Multilingual
Interpreting Department at the Cambridge Health Alliance. The department
provides oral interpreting, written translation, interpreting training,
cultural competency training, and advocacy for immigrant health rights.
She was a key collaborator in the development of the Medical Interpreter
Training Program at Cambridge College. Prior to her work in interpreter
services, she was a clinician at the Haitian Mental Health Clinic at Cambridge
Hospital. Loretta is a member of the Massachusetts Medical Interpreters
Association, the Interpreter Services Collaborative, the Massachusetts
Immigrant and Refugee Advocacy Coalition, and the Emergency Room Interpreter
Law Working Group. Her doctorate is in anthropology, from Boston University.
Loretta Saint-Louis, Ph.D.
Cambridge Health Alliance,
Multilingual Interpreting,
230 Highland Ave. SON 504,
Somerville, MA 02143
Ph: 617-591-6955
Fax: 617-591-6949
lsaint-louis@challiance.org
The Forum of Coordinators of Interpreter Services (FOCIS)
The Forum of Coordinators of Interpreter Services (FOCIS) developed
from an initiative of the Caritas Christi Health Care, the second largest
health care system in New England, which provides community-based medicine
and tertiary care in eastern Massachusetts, southern New Hampshire, and
Rhode Island. As a system, all six of our hospitals’ Coordinators
of Interpreter Services were meeting monthly to work collaboratively on
interpreter issues. Our group was approached by Coordinators of Interpreter
Services from other hospitals who wanted to join our monthly meetings.
Caritas Christi Health Care recognized the need to develop a venue for
Coordinators of Interpreter Services, and decided to initiate this process
by establishing FOCIS. The first meeting hosted on January 15th, 2003
at Caritas Good Samaritan Center, was open to Coordinators of Interpreter
Services across the state. More than 40 attendees representing over 30
different medical centers and hospitals, attended the meeting.
FOCIS developed from a Caritas Christi Health Care initiative; however,
it has evolved into the “work in progress” of all FOCIS member
organizations. FOCIS meets bimonthly at different hospitals across the
state. To date, FOCIS has met 7 times. Issues considered include sharing
resources and methods, interviewing freelancers and challenges of managing
an interpreter services program. We have out of state members attending
the meetings as well from Connecticut and North Carolina.
In the short time since our inception, we have done a large amount of
work. Among our most significant accomplishments is the development of
a Basic Standardized Interpreter Assessment Test to be utilized by all
FOCIS member organizations for assessing basic proficiency of medical
interpreters. This Basic Standardized Interpreter Assessment Test is designed
to reduce the amount of time and effort spent by FOCIS member organizations
and interpreter candidates taking repetitive assessment tests at different
facilities.
FOCIS is providing a venue for Coordinators to be able to discuss daily
operational issues related to running an interpreter services program.
It is our hope that FOCIS will serve as a wonderful resource and perhaps
a model for other states and Coordinators to follow or to join.
For more information about FOCIS, please contact:
Carla Fogaren R.N.
Director of Community Outreach & Interpreter Services
Caritas Good Samaritan Medical Center
235 North Pearl St, Brockton, MA 02301
Phone: 508-427-3570
Fax: 508-427-3645
Carla_Fogaren@cchcs.org
|
