• Why are foreign language interpreters required in Minnesota? (See The Challenge, page 3) 
• What professional standards should interpreters meet? (See Professional Standards Recommendations, page 11) 
• How should interpreters be trained? (See Training Recommendations, page 16 ) 
• How can the skills of interpreters be assessed? (See Proof of Skills Recommendations, page 19 ) 
• How can professional interpreters be used more often in health care and other community settings? (See Action Steps, page 23 ) 

 

Serving all Minnesotans

Minnesota, like the rest of the United States, was built by people who did not speak English as their first language. Our state--once peopled by speakers of Lakota and Ojibway--was later settled by immigrants who spoke Norwegian, German, Spanish and Swedish, as well as English. Today we welcome new peoples, speaking Hmong, Somali, Russian, or Vietnamese. Tomorrow, others will come, speaking different languages.

There are few hard numbers when it comes to counting the limited-English speakers among us. The 1990 Census, now nearly ten years old, says there are 80,000 people in Minnesota whose English proficiency is limited. Since 1990, the number of children in the state's public schools who do not speak English well has nearly doubled, from 20,000 in 1990 to 38,000 in 1995, according to the Minnesota Department of Children, Families and Learning.

Extrapolating from those facts, we can assume that there has been a very large increase in the total number of children and adults who are "limited English proficient," or LEP. Surely we are talking about at least 200,000 people, or one out of every twenty Minnesotans.

This growth mirrors the trend in other parts of the nation, where in five states (California, Texas, New Mexico, New York and Hawaii), more than one in ten people have limited English skills.

The largest numbers of non-English speakers are in Minnesota's Hmong and Spanish-speaking communities, but groups speaking African and Eastern European languages are also growing rapidly. 

--Office of Refugee Health, Minnesota Department of Health
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Immigrants and refugees have settled primarily in urban areas, but many communities in rural Minnesota have been transformed by recent influxes of newcomers, speaking Spanish, Somali, Vietnamese and Russian.

Newcomers to the United States and to Minnesota know they must learn English, the United States' language of education and commerce. But learning a new language takes time, especially for adult immigrants struggling to adjust to a new home.

In the meantime, residents or new citizens whose proficiency in English is limited are entitled to access the same health care and social services as those who speak English fluently. Not only that, according to federal law, they are entitled to the same quality of service, including unimpeded communication with the service provider.

Title VI of the Civil Rights Act of 1964 prohibits discrimination against any person on the basis of race, color or national origin in any program receiving federal assistance. Title VI has repeatedly been interpreted by the federal Office of Civil Rights to mean that trained and qualified interpreters must be provided in health care and other settings.

In 1997 the Minnesota legislature directed the Commissioner of Human Services to ensure that the state is in compliance with Title VI, and to develop a plan to serve public assistance recipients and recipients who have limited English skills.

Both federal and state laws repeatedly recognize the rights of limited English speakers. But too often, these rights are overlooked. In health care, especially, this neglect can have serious consequences.

"No person in the United States shall, on ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal assistance."

Minnesota Statutes 1995 (15.441)

"Every state agency that is directly involved in furnishing information or rendering services to the public and that serves a substantial number of non-English-speaking people shall employ enough qualified bilingual persons in public contact positions, or enough interpreters to assist those in these positions to ensure provision of information and service..."
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Professional Health Care Interpreters

The need for clarity and understanding is paramount in any setting where people seek services. But in a hospital or clinic, life-and-death-decisions hinge on immediate, accurate communication. The consequences of poor communication can be devastating. Inaccurate history-taking, unnecessary testing, and misdiagnosis are just a few of the risks.

Federal law recognizes these potential risks to health care consumers by mandating "linguistic accessibility to health care" under Title VI of the Civil Rights Act. Minnesota law also requires public health care institutions to provide services to people with limited English proficiency.

In addition, health care accreditation systems have adopted standards that underscore the need for language access. The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to "have a way of providing for effective communication for each patient served," while the National Committee for Quality Assurance, which accredits managed care organizations, has stipulated that the provision of medical interpreters is essential to overcome the communication gap between providers and non-English-speaking patients.

Minnesotans with limited English skills have trouble gaining access to our state's health care system. Bilingual health care providers are few. For example, although there are nearly 50,000 Hmong people living in Minnesota, the state has only six Hmong-speaking physicians. There are no Somali-speaking physicians licensed to serve the state's estimated 12,000 Somali refugees. Hundreds of Spanish-speaking patients are served each year by Madelia Community Hospital in southern Minnesota, which in spring of 1998 had one bilingual nurse, and no trained interpreters.

Title VI of the Civil Rights Act The Hill-Burton Act

Medicare

Medicaid

Categorial Grant Programs

Emergency Medical Treatment and Active Labor Act
 
 

Minnesota Laws on Language Access in Health Care "Bilingual Services Act "1995 (MN Statutes 15.441, Subd. 1) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Metropolitan hospitals such as Hennepin County Medical Center, Regions Hospital and Mayo Medical Center have attempted to comply with state and national laws by hiring full time foreign language interpreters; for example, Mayo Medical Center has 80 interpreters on the payroll.

But the demand far outstrips current supply. Facilities which have hired interpreters find themselves virtually overwhelmed with the demand for their services: Hennepin County Medical Center's 46 interpreters (31 fulltime, 15 on-call) made over 54,000 individual patient visits in 1997, serving patients who spoke Spanish, Somali, Russian, Amharic, Chinese, and 34 other languages.

When interpreters are not available, providers will often resort to using family and friends. The use of untrained, "volunteer" interpreters is rife with hazards: in one study of recorded ad hoc interpreter-assisted encounters, 25% to 50% of the words and phrases were incorrectly relayed. Using family members and friends as interpreters undermines patient confidentiality and privacy and in many instances is completely inappropriate, violating family roles and boundaries. According to the U.S. Office of Civil Rights, the use of children as interpreters or requiring patients to provide their own interpreters is a civil rights violation.

Equal access for limited English-speakers is the law. Beyond complying with a legal mandate, however, community and health systems should have many other reasons for wanting improved access for LEP clients and patients. Minnesota's legal system has already recognized the benefits of providing interpreters in the court room, and mandates the use of trained interpreters in all state courtrooms.

In one widely cited incident, a seven-year old girl was asked to tell her mother what an ultrasound examination had revealed: that the woman's fetus was dead in utero.
 
 
 
 

A teenager incorrectly interpreted a Minneapolis physician's directive for x-rays, and told his mother that she was going to be microwaved.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Health care systems have been slower in recognizing that better access leads to:

Better health outcomes

It's common sense that clear communication can ensure more accurate diagnosis and follow-through with medications and treatment regimens. An interpreter can help a physician avoid costly, unnecessary diagnostic tests, which are inconvenient at best, and at worst expose a patient to the risks of false-positive results.

Ethical patient care

Direct communication with a patient through a trained interpreter, not a family member, reduces the likelihood of misunderstanding and helps ensure informed consent. Informed consent and respect for the expressed wishes of the individual are the hallmarks of patient autonomy--a basic ethical principle in Western medical practice.

Better quality care

Health care providers can respond more promptly and sensitively and can understand the health needs, goals and desires of their patients if the language barrier is removed.

Money and time saved

Providers lose time trying to communicate with a patient through untrained intermediaries. Encounters can take longer, and expensive tests may be required. Systems lose money if frustrated patients take their business elsewhere, or if they cannot understand what they are told about the billing process. Patients whose medical problems go undetected and untreated as a result of miscommunication often show up later in the Emergency Room with much more serious complaints.

Legal action prevented

Misdiagnosis and miscommunication regarding treatment can, of course, lead to costly lawsuits.

--Language Barriers in Medicine, Woloshin, et al, 1995 Journal of the American Medical Association
 
 

"Courts have held that a physician's failure to overcome language barriers in treatment can establish a lack of informed consent."

--Ensuring Linguistic Access in Health Care Settings, Kaiser Foundation report
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Courts in various states have ruled in favor of plaintiffs who were unable to understand what a health care provider was trying to communicate to them, and have ruled that it is the provider's professional responsibility to overcome any language barrier.

The benefits that accrue to health systems using properly trained foreign language interpreters have corollaries in other community services. 

Teachers and parents can further the educational goals of a child they care about only if they can communicate freely. Protecting the rights of both crime victims and suspects relies upon accurate, detailed information. Tenants' and landlords' rights and responsibilities can be fully understood only if the language gap is bridged.

This report focuses on the problem created when the health care system ignores the language gap, but its proposed solutions can apply to many other facets of our community life.

"Courts have construed professional standards of care to find that in cases where a language barrier exists between a physician and a patient, the doctor has a duty to take adequate steps to be certain that he fully understands the patient's complaints."

Ensuring Linguistic Access in Health Care

Kaiser Foundation Report
 
 
 

DEFINING QUALIFIED INTERPRETERS

Interpreters in health care and other community settings assume professional responsibilities. Like all professionals, they must be qualified, i.e., they must adhere to a set of standards of competence and ethics; receive appropriate training; and be able to demonstrate their skills.

Interpreters for the deaf in Minnesota undergo rigorous training, subscribe to a national code of ethics and standards, and must be certified.

In contrast, only language interpreters working in Minnesota's legal system are required to undergo any training at all. To be hired in the state court system, interpreters must pass an ethics examination and attend a two-day training session. To demonstrate that they are fully qualified, legal interpreters must then pass a difficult certification exam. As certification tests are developed for more languages, the state courts will be required to use only interpreters who meet this certification.

Standards and requirements for foreign language interpreters working in any community setting should at least match those of interpreters working in the courts.

The next part of this report consists of the Working Group's recommendations for standards, training and proof of skills for foreign language interpreters.
 
 

--Medical Interpreting Standards of Practice, Massachusetts Medical Interpreters Association
 
 
 
 
 
 
 
 
 
 
 

BACKGROUND

The essential role of the interpreter is to make it possible for two or more individuals who do not share a common language to communicate directly with each other as if they did.

Many people speak more than one language, but simple bilingualism is only the beginning of interpretation. Skills central to the interpretation process include:

• a broad knowledge of both languages and cultures in which they are spoken; 
• the ability to grasp readily and completely what others say in either language; 
• the ability to speak in either language so as to be readily understood; 
• a good memory for what is said; 
• the ability to find equivalent means of expression in each language even when here are no equivalent words; and 
• a knowledge of specialized vocabulary and concepts in areas such as medicine and law. 

Quality interpreting also requires that the interpreter understands a set of core competencies, and adheres to a code of ethics. These are outlined on the next three pages.

--John Nicrosz, president of the Massachusetts Medical Interpreters Association
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

RECOMMENDATIONS

Core Competencies

Any job can be broken down into separate tasks, each requiring different skills, or competencies. Core competencies are those skills which interpreters must master in order to carry out their professional role. The Working Group recommends the following ten core competencies for interpreters. 

The competent interpreter:

1. Introduces self and explains role.

Ideally, the interpreter consults first with the provider to learn the goals of the medical encounter, and with the patient to assess language requirements. Then, if this is their first meeting, the interpreter explains his role to both the patient and the provider. The interpreter must emphasize the professional obligation to transmit everything that is said in the encounter to the other party and to maintain confidentiality. 

The interpreter should be seen and heard by both parties, but should position herself in the place that is least disruptive to direct communication between provider and patient, and most respectful of the patient's physical privacy.

The interpreter converts oral messages expressed in one language into their equivalent in the other, so that the interpreted message can elicit the same response as the original. The interpreter does not alter or edit statements from either party, or comment on their content. The goal is for the patient and the provider to feel as if they are communicating directly with one another.

These competencies are written to apply to health care interpreting, but with few exceptions, can apply to the job of interpreting in social service or other community settings.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

The interpreter encourages direct communication between patient and provider, using whatever modes are appropriate. Usually, the best mode will be to use "I..." in reference to the speaker, rather than "he said that..." or "she said that..." and to interpret for the patient and the provider alternately (known as consecutive interpreting.)

The interpreter attempts to preserve the register (special vocabulary and level of formality) as well as the emphasis and degree of emotion expressed by the speaker.

The interpreter asks for clarification or repetition if the message from either party is unclear.

In situations where there is conflict between patient and provider, the interpreter continues interpreting completely, lets the parties speak for themselves, and does not take sides.

The interpreter does not project his own values into the discussion.

The interpreter checks the accuracy of her own interpretation.

The interpreter identifies instances in which cultural differences between provider and patient have the potential to seriously impair their communication. In those instances, the interpreter shares cultural information with both parties that may be relevant, or assists the speaker in developing an explanation that can be understood by the listener.

This list of core competencies is based on the "Massachusetts Medical Interpreters' Association Standards of Practice," a document developed in 1995 by the Massachusetts Medical Interpreters Association and Educational Development Center, Inc.

Those standards were endorsed in 1998 by the National Council on Interpretation in Health Care.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Codes of ethics are guidelines that help interpreters maintain professional relationships with colleagues and clients. The Working Group recommends the following set of professional ethics standards for interpreters.

An ethical interpreter:

1. Maintains confidentiality.

Information divulged in any interpreted exchange--for example, between a patient and a health care provider--is private. The interpreter does not intentionally reveal confidential information.

The interpreter is committed to transmitting the content and spirit of the original message into the other language without omitting, modifying, condensing or adding.

The interpreter withdraws from assignments where personal ties or beliefs may affect impartiality, and refrains from interjecting personal opinions or biases into the exchange.

The interpreter understands the boundaries of the professional role and monitors her own personal agenda, refraining from becoming personally involved in a patient's life.

The interpreter declines to interpret beyond his training, level of experience and skills. In addition, he avoids situations that may represent a conflict of interest or may lead to personal or professional gain.

The interpreter clearly understands her role and refrains from delivering services that are not part of that role. The interpreter conducts herself in dress, posture and speech in a manner appropriate to the situation, and is respectful, courteous and honest.

These ethical standards are also based on the Massachusetts Medical Interpreters' Association Standards of Practice.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

BACKGROUND

Good interpreters are trained, not born.

Comprehensive training is needed for a bilingual person to become an effective interpreter. Ideally, such training should take months, or even years. A recent survey of U.S. and Canadian interpreter training described programs as brief as six hours, and as long as three years. 

Minnesota's courts have recognized the need for trained interpreters, and have begun requiring court interpreters to pass a certification test. The state is part of a 12-state consortium working on national standards for the certification of court interpreters. In contrast, only Washington state insists on training and certification for medical interpreters.

Health care and social service facilities often provide on-the-job or short term training for staff who are recruited as interpreters. For example, the Neighborhood Health Care Network offers training for interpreters they provide to Minneapolis and St. Paul community clinics. But very few interpreters working in Minnesota have such training. Only 50 individuals have passed through all of the introductory and intermediate level courses of the Program in Translation and Interpreting at the University of Minnesota, the only such program in the state.

In 1996, the Legislature directed the Minnesota State Colleges and Universities (MnSCU) to develop a statewide model instruction program in interpreting and translation. Although such a plan was developed, based on the University of Minnesota's existing courses in interpreting, the plan lacked an implementation structure, and it was never funded.

--New York City Hospitals and Heath Care Corporation,1986 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Minnesota still needs a comprehensive training curriculum that is accessible statewide to anyone wishing to become a spoken-language interpreter. Currently, there is no such program, although a partial program exists at the University of Minnesota. (See Appendix 5 for a description of the program.)

A complete training curriculum would require basic language proficiency in two languages as a starting point. Would-be interpreters should then be able to gain basic skills, qualifying them for some kinds of community interpreting work. If they choose, they can continue to develop advanced and specialized competencies, enabling them to work as legal or medical interpreters.

Interpreter training programs should address the unique skill of the interpreter--the ability to relay accurately in another language the meaning expressed by another person. The training should stress interactive skills, such as making introductions and asking for clarification, and technical skills, like note-taking. Interpreters should learn both simultaneous and consecutive modes of interpretation, and to translate written documents orally, on sight.

In addition, interpreters should be taught how to conduct themselves in a professional and ethical manner. Finally, providers and consumers must themselves learn how to make the best use of a trained interpreter's services.

RECOMMENDATIONS

The Working Group agreed on recommended parameters for a multi-site, statewide, two-year pilot training program for interpreters in health care and other community settings. These are outlined below.

In the first year of training: to develop general interpreting skills. 

After a second year of training: to acquire the knowledge and skills necessary to work as an interpreter in specialized arenas such as health care or law.

Individuals with demonstrated bilingual proficiency and interest in the field, with priority given to those who speak languages that are in demand for interpretation in Minnesota. Minimum size of each year's training cohort: 64 enrollees total in three sites.

An accredited university and/or community college.The University of Minnesota provides coordination, lead instuctors, course materials and instructors' manuals. Course credits should be transferrable.

Three proposed pilot sites:

Primary site: University of Minnesota-Twin Cities, possibly paired with Century College or the St. Paul Technical Vocational Institute.

Second site: University Center-Rochester, in collaboration with the Mayo Clinic in Rochester.

Third site: to be determined (site in southwest or northwest Minnesota strongly recommended).
 
 

--Comment written by a Minnesota interpeter attending the September 24 Working Group meeting for interpreters
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

All courses beyond the first course would include laboratory sessions supervised by bilingual instructors. Courses uniform in content and transferrable.

Two courses: an introduction to interpreting and intermediate interpreting. The courses would emphasize the role, ethics and skills needed to interpret, and offer lab instruction. 

Fundamentals course: Fundamentals course in health care or law, as a bridge to specialized courses.

Specialized courses: One course in interpretation for legal or medical settings, plus a practicum in either setting. 

Courses taught in sequence, usually one course per semester, requiring two to two-and-a-half years for completion.

Basic courses :Two semesters or 90 classroom hours.

Fundamentals course : One semester or 45 classroom hours.

Specialized courses : One semester or 45 classroom hours, plus practicum hours.

Basic courses :Bilingual proficiency, as established by examination.

Specialized courses : Completion of first year and fundamentals of health care or legal system course.

Experienced in interpreting. Lead instructor position requires bachelor's degree. Assistant instructors with bachelor's degree preferred. Instructors' manual with texts and materials available for each course.

1. The University of Minnesota campus, Mpls/St Paul

2. University Center-Rochester

3. A community college in southwest or northwest Minnesota
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

BACKGROUND

Individuals seeking to establish a record of their skills and training as professional interpreters have no common system of certification or validation in Minnesota. Employers seeking to assess the skill level of would-be interpreters also have a difficult time. What is needed is a simple, consistent way to establish an interpreter's skill level.

The skill level of a trained interpreter can be certified by others who are capable of assessing their professional competence. Such assessment or even certification provides a measurable standard which allows employers to know whether the interpreters they hire meet at least minimal competence criteria. 

Certification can be provided by an educational institution, by a state agency or by a professional association. The Association of State and Territorial Health Organizations has recommended that state health agencies set and enforce quality standards for medical interpreters. 

To date in the U.S., however, only Washington state has instituted a certification program for medical and social service interpreters. It requires interpreters hired by agencies with state contracts to pass an examination administered by the Washington Department of Health and Human Services.

In Minnesota, the Department of Administration is in the process of producing a list of interpreter services which will be approved for contracts with state agencies. 

--A Minnesota interpreter agency owner, at the September 24 Working Group meeting for interpreters
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

RECOMMENDATIONS

The Working Group recommends a two-tiered system of assessing the proficiency of interpreters. Tier 1 establishes a minimum level of testable skills and recommends basic training for all interpreters; Tier 2 establishes recommended levels of skill and training for interpreters in specialized settings, such as health care.

Bilingual proficiency

Recommended : All individuals hired to perform interpreting services should, at minimum, be able to demonstrate oral proficiency in each language through a test developed by the American Council of Teachers of Foreign Languages (ACTFL). An ACTFL score of "advanced-mid" level is recommended. (See Appendix 3 for more information on this test.)

Recommended : All individuals hired to perform interpreting services should, at minimum, pass a test of comprehension of ethical standards. This test will be developed, based on the ethics standards endorsed by the Working Group.

Recommended : In addition, it is recommended that all individuals hired to perform interpreting services complete basic courses in interpreter training offered through the University of Minnesota/ MNSCU system (Introduction to Interpreting and Intermediate Interpreting.)

Specialized skills

Recommended :All individuals hired to serve as health care interpreters in Minnesota should pass a state health care interpreter certification test. This is an oral test to be developed, modeled on the Court Interpreter test now offered in Minnesota and on other certification exams. This test should establish a testee's bilingual proficiency as equivalent to the ACTFL "Superior" level. (For more information on the ACTFL test, see Appendix 3)

Recommended :All individuals hired to serve as health care interpreters in Minnesota should complete the basic courses as previously outlined, plus the courses in medical interpreting, to be offered through the UM/MNSCU program. (Fundamentals of Health Care for Interpreters; Interpreting in Health Care Settings; and a practicum.) Training, though not required for certification, will benefit even those interpreters who pass the certification test.

Recommended :Individuals who have passed the health care interpreting certification test (to be developed); have significant experience as a medical interpreter and have recieved advanced training in medical interpreting can be considered to possess advanced medical interpreting skills. Continuing education for interpreters should be made available through employers, professional associations and educational institutions.

BACKGROUND

Increased training, higher professional standards and greater utilization of health care and community interpreters will greatly benefit Minnesota's social service and health care systems. But few benefits are truly free. For Minnesota residents to enjoy equal access to health and social services that all are promised, regardless of the language they speak, we will have to manage the costs implicit in keeping that promise. 

A comprehensive statewide training program for medical interpreters will cost money, as will a new system of certification for the interpreting profession. Using trained professional interpreters will cost health care and social service agencies more than relying inappropriately on untrained friends and family members.

The hidden costs of the status quo must be acknowledged as well, in any cost-benefit inventory. 

What is the health cost of denying full access to care to a significant proportion of Minnesotans? 

What is the potential liability faced by institutions whose patients or clients feel they are denied access?

In its deliberations, the Working Group made an effort to estimate the costs of improving interpreter services statewide, for a two-year pilot period. A budget for this period appears on the next page. 

To adequately serve its growing LEP population in 1997, Hennepin County Medical Center spent over $1,000,000 in costs related to interpreter services.
 
 
 
 
 
 
 
 
 
 

Consider the Benefits

What benefits accrue to social service and health care providers who bridge the language gap between themselves and their newest patients?
 
 
 
 
 
 
 
 
 
 
 

Recommended

This budget is for a two-year pilot period, beginning in 1999. Staff coordination is needed for the following tasks:

• disseminating the professional standards to working interpreters, their employers and other agencies that serve Minnesotans with limited English 
• guiding the development of training programs at three pilot sites 
• promulgating a system to test professional skills 

Funding should come from a public-private partnership, including state agencies, the state colleges and universities, the legislature, private foundations and businesses. Interpreters will also bear some of the cost of their own training, through tuition fees.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

RECOMMENDED

Below are just a few ways in which every stakeholder reading this report can act on the recommendations in it. You can contact any member of the Working Group to express your interest.

• collect data on needs of LEP populations. 
• research the benefits and costs of increased use of professional interpreters. 

• monitor health and community organizations' use of interpreters; protest the use of family members and unqualified interpreters. 

• hire and contract with interpreters who meet the standards outlined in this report. 
• require training for providers on working with interpreters. 

• insist on working with trained professional interpreters who meet the standards outlined in this report. 

• seek appropriate training. 
• help form a statewide organization of foreign language interpreters. 

• promote the enforcement of rights guarantees in existing laws. 

• make Medicaid provider contract guidelines comply with OCR requirements. 

As of November, 1998, the Working Group of the Interpreter Standards Advisory Committee has been funded for three months to begin implementing the recommendations in this report.
 
 

Follow the Working Group's progress or get involved: consult the Web site at

www. umn.edu/ccch

(click "Interpreter Standards")

or call coordinators Barbara Babbitt and Patricia Ohmans at (651) 489-4238.