Recommendations for Translation and Interpretation
The first recommendation has less to do with increasing the availability of translation and interpretation in the region (though it may help in this regard), and more to do with making sure that those who provide translation and interpretation are fairly compensated. Knowing more than one language is a valuable skill, and individuals who use that skill should be paid for their services whenever possible. It may not always be appropriate or practical, but it is a best practice that should be considered the norm in this region. Doing so not only helps those community members who volunteer their services, but also encourages additional immigrants and multilingual people to offer their services.
One common problem for both interpreters and organizations is an uncertainty around how much these services should cost. Many factors go into this calculation, including the experience the individual has, any technical requirements, the necessary timeline for the translation, etc. The appropriate value will also likely change over time. However, a good template may be that used by the City of Dubuque. For translation and interpretation, they provide:
- 19 cents per word for written translations,
- 25 cents per word for translations that must be completed in 24 hours or less, and
- $30 per hour for interpretations or making short videos.
These numbers should be reassessed in future years, as appropriate compensation for 2022 may be inadequate in the future due to inflation and other rising costs.
This recommendation also appears under Navigators and as Recommendation 1 under Health
One of the most effective ways for organizations to ensure available translation or interpretation is to hire staff from within immigrant communities who can serve as navigators. Navigators help resolve one of the most imposing barriers facing residents of this region: the challenge of navigating support systems. Understanding what step to take next, how to fill out a form correctly, or who to call for help can be extremely difficult for many people, and especially lower income individuals.[1] For immigrants these problems may be compounded by a lack of familiarity with local systems, language challenges, and a cultural or societal fear of being seen as causing problems. Some immigrants may simply avoid seeking services instead of dealing with the potential for failure and humiliation.
The addition of navigators can be a major benefit for helping resolve these issues. Navigators are individuals employed or utilized by service providers to help assist community members with accessing services. The best navigators are those that are both trained in the requirements of service systems and come from the communities they serve, providing them with the language and cultural knowledge to effectively help. These navigators can leverage trust and relationships within immigrant communities to make sure that a greater number of people are able access important services. Hiring additional navigators, especially at organizations or government departments that regularly serve immigrant communities, can be an extremely beneficial way to improve engagement with local populations.
Excellent examples of valuable immigrant navigators already exist within Dubuque. These include community health workers at Crescent Community Health Center, paraprofessionals at the Dubuque Community School District, family navigators at Child Health Specialty Clinics, and staff at the Northeast Iowa Community College. Many other organizations, such as institutes of higher education, also have staff that, while not navigators, may frequently serve a navigator role. Several navigator positions were also created as a result of collaborations connected with this research, including the Guatemalan Mentor program and the Marshallese community connector at the Visiting Nurse Association (see Projects and Accomplishments Connected with the Community Assessment for more information). This is by no means an exhaustive list of navigators in the region, but is meant to be provide examples of existing navigators who are members of local immigrant communities.
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However, while hiring navigators is an undoubtedly powerful tool for helping improve access to services for immigrant populations, it should not be seen as a substitute for capacity and power building. Navigators can serve an important role, but still are meant to move forward the mission of the organization they work for and follow the direction of their (usually non-immigrant) managers and bosses. This is a very valuable and necessary part of how service organizations in this region work, and navigation plays a critical role in helping to provide equitable access to systems. But it should still not be seen as a replacement for advocacy and power building within immigrant communities.
The role of navigators is especially important in healthcare. Health services can be an intimidating experience, especially if there are language and cultural barriers. Misinformation about medical issues can be common, especially during a health crisis like the Covid-19 pandemic. Understanding what information is correct or how to best engage with complex systems like insurance or medical billing can be very difficult for community leaders and volunteers that are supporting immigrant families. Having a trusted individual who is knowledgeable about health-care systems and paid to assist members of their local community can be a huge asset. Health-care providers and related organizations should consider creating more navigator positions staffed by members from immigrant communities, such as community health workers or community connectors.
An example of previously recommended program that can fulfill some of the roles of a navigator position is the Natural Helper program. While this is not a substitute for having a paid staff position dedicated to navigation, training and compensating immigrant volunteers to help members of their communities navigate systems can increase access to services. The Natural Helper program is described in more detail in the Capacity and Power Building Section.
Sometimes accessing national and state services can be the simplest way to communicate with immigrant populations. For example, many organizations in this region (such as hospitals) utilize LanguageLine Solutions[2] to have consistent access to interpretation services for clients. These options can be valuable resources, especially for organizations that require frequent translation and interpretation services. However, they can also be expensive, and interpretation is generally considered most effective when it is done in-person. Having an interpreter from the community that is known to the client can also be valuable for building trust. So while these options should be utilized as needed, it is also important for communities to develop local resources for interpretation and translation.
Some potential options that are available include:
- Language Line Solutions (www.languageline.com) offers a wide variety of languages for interpretation, and includes the use of technology like teleconferencing.
- Capital Linguists (www.capitallinguists.com) provides translation and interpretation services, including in Marshallese and several Afghan languages.
- The Iowa Interpreters and Translators Association, Inc. (www.iitanet.org/) is an organization with a membership of accredited Iowa-based interpreters and translators, and includes a directory of interpreters and translators.
As discussed above, there is often a local need for interpreters and translators who can be available to assist in different situations. There are currently a number of individuals in this region who provide these services, some of whom have specialized skills like training in medical translation. While most of these individuals do not have the accreditation to be listed and used by organizations as a licensed translator or interpreter, they still provide incredibly valuable services on a regular basis. Yet it would be a significant benefit if these translation services became more standardized and easily accessible. Currently in many parts of this region, if someone needs translation or interpretation, they either reach out to one or two community members they have a relationship with, or else contact local organizations looking for referrals. This can lead to certain individuals being overused, or challenges if a regularly used interpreter is not available. It can also result in reliance on interpreters and translators of poor quality or who may struggle with more technical interpretation.
In addition, outside of institutions that have set policies around payment for translation and interpretation, many organizations and individuals are uncertain about rates and the other details that are relevant for hiring a translator or interpreter. This can lead to informal agreements that may not include fair-market rates, or any compensation at all. It can often mean that the translators and interpreters may have very little training or understanding about what is required of a translator and interpreter, which could lead to issues.
A possible way to lessen these issues is through the development of a centralized database that lists translators and interpreters as independent contractors. This list could contain names, contact information, languages, translation specialties (medical, legal, etc.), and any special requirements that translators and interpreters may have. It could also be displayed publicly or be available through contacting the host organization. The site could also list expected interpretation and translation rates, as well as guidelines about rush requests, work over the weekend, and other additional factors.
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Such a database would likely require a lead organization that would host and maintain this site, adding and removing interpreters as needed. This effort may require funding both for the site and for the staff person directing the work. The host organization may also have several additional responsibilities, including:
- Briefly screening new interpreters to make sure they had sufficient language skills to be interpreters (this could be something with which other interpreter/translators on the list could assist).
- Serving as a place for responses or complaints in case there are issues with a specific interpreter or translator. Any host organization should remember to set a policy about this that all interpreters and translators will understand (such as a three strikes policy).
- Providing training, either through staff or selected volunteers, for new interpreters looking to be part of the database. This would help provide each of the interpreters with additional support, and would help them with some difficult issues, such as:
- Rates
- Rush jobs/weekend jobs
- Setting agreed upon products
- Possible certification and other advancements
- Basic invoices/other documents people may need
Models to consider:
- The City of Dubuque is putting together a list of local translators and interpreters that it will place on its Equity and Human Rights website.
- This research was unable to identify other community-based databases of local interpreters and translators constructed in exactly this manner. However, the following are examples of some ways in which this database could operate:
- The Iowa Interpreters and Translators Association, Inc. is an organization with a membership of accredited Iowa-based interpreters and translators, and includes a directory of interpreters and translators that includes languages spoken.
- The University of Iowa Human Subjects Offices provides a list of translators in the Iowa City-Coralville area who were willing to have their contact information shared with investigators.
While the most important part of translation and interpretation is being able to speak multiple languages, there are other skills, pieces of knowledge, and ethical considerations that are important for being an interpreter. Often when community members interpret, they may do things that often feel very natural, but can create confusion and misunderstanding. For example, they might modify what one person said in an attempt to make it more understandable, or they might try to answer questions separately without translating. While in some cases these decisions do not cause problems, in others they might lead to misinterpretation and significant issues.
One option is for communities to develop a short, basic training regarding interpretation and translation. While there are many national trainings on interpretation that should be considered (see the next recommendation, Offer Training for Medical Translation and Interpretation), these may not be necessary for community members who regularly volunteer to provide translation or interpretation. A shorter training by someone familiar with translation and interpretation could provide valuable guidance to amateur interpreters. Such a training could also be included in the previous recommendation, Create a Local Translation and Interpretation Database.
This recommendation also appears as Recommendation 4 under Health
One significant gap in this region is for licensed medical interpreters and translators, especially for languages like Marshallese that are not commonly spoken throughout much of the United States. Many health-care providers require certified medical translators to make sure that they can correctly translate the technical terms used by staff. However, in many instances these interpreters are not available, and so the providers rely on untrained community members for interpretation. At times, young children have been asked to provide translation when there is no other readily available option. Not only is this potentially inappropriate and could lead to significant mistranslations, but in many cases health-care providers are unable to compensate non-certified interpreters.
This region, and especially locations like Dubuque where languages are commonly spoken that do not have readily available translators, should work to develop the support process and funding to help interested community members become certified for medical interpretation. Courses and tests can be expensive and take extensive time, so it will be important to have individuals who can assist with navigating systems and funding to help cover costs. While the best process and programs may vary from area to area, the following is an option that communities could consider:
- The Certification Commission for Healthcare Interpreters (CCHI)[3] offers several accreditations that are accepted by many health-care providers.
- For Spanish, Mandarin, and French, CCHI offers its Certified Healthcare Interpreter (CHI) certification.
- For other languages (such as Marshallese), CCHI offers its Core Certification Healthcare Interpreter (CoreCHI) certification. Due to the big lack of interpreters for less commonly spoken languages, this report will primarily discuss the CoreCHI.
- Applicants for the CoreCHI and CHI certification must meet the following requirements:
- Be at least eighteen years of age.
- Have received a high school diploma or equivalent from any country.
- Be able to demonstrate proficiency in both English and the language of interpretation. This can be done with:
- A high school diploma or equivalent from a country that teaches in the language;
- Successfully passing a language proficiency test from a reputable testing organization;
- A list of suggested English language testing options are available at the CCHI site.[4]
- The TOEFL Essentials test provided by ETS allows for remote testing online.[5]
- Sites such as Language Testing International (LTI) offer widely accepted language proficiency certificates.[6]
- LTI does not currently appear to offer language testing in Marshallese. For Marshallese, the Avant STAMP WS test is available and accepted by CCHI.[7]
- A list of suggested English language testing options are available at the CCHI site.[4]
- Other options are listed in the CCHI Candidate Examination Handbook.[8]
- Completion of a minimum of 40 hours of training (not experience) in health-care interpreting.[9] See “Models to consider” below:
- The CoreCHI examination includes $210 worth of fees. The CHI Examination includes an additional $275 of fees.
Models to consider:
- Heartland Regional Genetics Network provides a medical interpretation training for Marshallese interpreters that fulfills the 40-hour requirement. Several community members have taken part in this training.
This recommendation also appears as Recommendation 5 under Health
Separate from medical interpretation and translation, brain health[10] or counseling interpretation requires additional training and commitment for an interpreter. Due to the personal nature of counseling services, an interpreter may become a major participant in any session. Any interpreter would need to have additional training on how to properly participate in counseling sessions, how to correctly interpret for the brain health specialist, and how to operate ethically and confidentially during the sessions. Trust is a key component of this kind of interpretation, so finding the correct, committed interpreter can be challenging. It is recommended that any effort to recruit translators for counseling sessions be coupled with training and a very thoughtful recruitment process. For more on brain health services for migrants and immigrants, see Provide Brain Health Services in the Health section.,
Models to consider:
- The Iowa Refugee Counseling Center in Iowa City holds counseling sessions for refugees and other immigrants. As part of their counseling sessions they use interpreters who are trained by the Center. Dr. Noemi Ford, who runs the Center, is able to provide trainings for interpreters on how to be successful interpreters for brain health sessions. Dr. Ford could be contracted to provide training sessions for community members who are interested in serving as translators.
- This training should be accompanied by a training of counselors or brain health providers as well. Both the counselor and the interpreter should understand their roles and how to work cross culturally.
- https://www.iccompassion.org/refugeecounseling
- The Marjorie Kovler Center, a Chicago-based program providing trauma-informed care to survivors of torture, has previously offered training sessions for interpreters.
- The National Council on Interpreting in Health Care has produced a working paper titled “A National Code of Ethics for Interpreters in Health Care.” This document provides useful information for potential translators and service providers regarding interpretation for brain health.
- The manual can be accessed at: https://www.ncihc.org/assets/z2021Images/NCIHC%20National%20Code%20of%20Ethics.pdf.
Recent years have seen impressive developments in new technology that assists with translation and interpretation. As the technology continues to improve, it will be important to look closely at new products to understand how they can fill existing gaps. However, for the near-term at least, it is also important to not let pursuit of new technology products draw attention away from developing local interpretation and translation capacity. This research was not able to identify a technology that is satisfactorily able to address all of the needs of local communities and organizations, especially when it comes to speaking Marshallese or Mayan dialects. Translation technology can be a useful tool, but attempts to treat it as a panacea should be viewed skeptically until additional research and pilot programs demonstrate their true utility.
Models to consider:
- The City of Dubuque is currently conducting a review of LanguageLine[11] usage within the City, and with external partners. Findings from this assessment could provide valuable translation support options for local organizations, especially with Spanish.
- Several organizations and individuals in Dubuque have begun piloting the use of Timekettle translation earbuds. These earbuds provide interpretation for two people wearing the earbuds, allowing them to talk back and forth without needing to have an interpreter present. At the time of this writing, the earbuds do not support translation for the Marshallese language or Mayan dialects. While this report cannot currently state whether these will be valuable tools for local service providers and other stakeholders due to a lack of experience with the devices, local partners should share their experiences to determine what role they these earbuds could play in the community.
[1] See the following link for an article discussing some of the challenges of navigating government support services: Lowrey, Annie. “The Time Tax.” The Atlantic. 27 July 2021. Available at: https://www.theatlantic.com/politics/archive/2021/07/how-government-learned-waste-your-time-tax/619568/https://www.theatlantic.com/politics/archive/2021/07/how-government-learned-waste-your-time-tax/619568/
[4] “Frequently Asked Questions.” CCHICertification.org. Available at: https://cchicertification.org/certifications/faq/
[5] “TOEFL Essentials Test Resources.” ETS.org. Available at: https://www.ets.org/s/toefl-essentials/test-takers/
[6] https://www.languagetesting.com/
[7] https://avantassessment.com/stamp-ws
[8] For more details, see the CCHI Candidate Examination Handbook, available at https://cchicertification.org/uploads/CCHI_Candidate_Examination_Handbook.pdf.
[9] A list of potential training programs are listed here: https://cchicertification.org/prerequisite-programs/
[10] The Community Foundation uses the term “brain health” when talking about conditions related to a person’s psychological and emotional well-being. The reason for this is to fight against the stigma often associated with the term “mental health.”
[11] www.languageline.com
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