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Process of Inquiry - Communicating in a Multicultural Environment

=Trained or Certified Interpreters. The use of professionally trained interpreters is considered best practice and can improve the quality of care to patients with limited English proficiency (Jacobs et al., 2001; Lears & Abbott, 2005; Rhodes, 2000; Oquendo, 1996).

Although national certification for medical interpreters is still not available, standards for quality medical interpretation have been developed in California by the California Healthcare Interpreters Association (CHIA), and in Massachusetts by the Massachusetts Medical Interpreters Association (MMIA) Further, an assessment guide has been developed by the National Council on Interpreting in Health Care (NCIHC) recommending that interpreters be assessed in the following areas:

  • Basic language skills in the two languages,
  • Ethics and ethical decision making,
  • Cultural issues,
  • Health care terminology,
  • Integrated interpreting skills, and
  • Written translation of simple instructions.

The NCIHC, a national organization for health care interpreters, lists on its Web site 18 state associations for health care interpreters. Many of these state organizations offer training sessions, instructional meetings, and yearly conferences. Health care organizations interested in improving the language proficiency and interpreter skills of its bilingual and multilingual interpreting workforce can encourage and financially support their personnel to participate in these organizations where available.

As mentioned above, Hablamos Juntos is providing leadership in the development of promising and evidence-based practices in the field of language access, including interpretation. It offers many resources and strategies for health care organizations seeking to design, maintain, or enhance their interpretation services at

Community interpreter banks can be the most cost-effective way to provide a wide range of languages to a community, by sharing costs among partners, participants, or customers. An interpreter bank can take a variety of forms, including but not limited to: an accessible database of interpreters for a community; a community-based organization that provides the interpreters as needed; or a pool of interpreters shared by community hospitals, clinics, or other organizations with similar language access needs. For examples of such cooperative programs, see the following:

  • Louisville, Kentucky created an Office of International Affairs to serve as a clearinghouse of information and services to immigrants, refugees, foreign students, and all international visitors. This Office runs a community language bank. See

Numerous training opportunities are available for interpreters through organizations and colleges. One example is Cross Cultural Health Care, which offers medical interpretation training and other key resources at To link directly to the well-known training program “Bridging the Gap,” see

There are also widely used publications such as: Language Barriers in Health Care Settings, Health Care Interpreter Training in the State of California, and How to Choose a Language Agency, funded by The California Endowment (see, Publications section, Cultural Competency category); Providing Language Interpretation Services in Health Care Settings: Examples from the Field, funded by The Commonwealth Fund, see



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