| Standards History |
|
|
|
|
Click on the following links to learn more about the history behind the creation of CHIA Standards and their unique contributions to the field of healthcare interpreting:
Historical and legislative background Two historical events, the 2000 Federal Census and the Presidential Executive Order 13166 issued in August 2000 formed the backdrop for the development of healthcare interpreters standards in California.
While many hospitals across the state have developed interpreter services, sometimes as the result of a lawsuit, dramatic demographic changes, a critical patient care incident, or a desire to improve the quality of health care services, most hospitals do not have consistency in how interpreters are screened, tested, trained and evaluated. Interpreters themselves lack clear guidance to fulfill the complex task required of them. At that juncture, CHIA saw the need to create guidelines that will establish consistent performance expectations for all healthcare interpreters practicing in California. We set out to formulate the vision and goals for filling such need. It should be noted that our vision and objectives for CHIA Standards were grounded not only on our collective expertise and experience, but also on research and theory of interpreting, specifically as it relates to the healthcare setting.
Support and funding from The California Endowment (TCE) CHIA is grateful to The California Endowment for embracing our vision and for selecting CHIA as one of the first grantees within their “Language Access Initiative, which has a goal of ensuring access to quality health care for LEP health consumers” as stated by Robert K. Ross, M.D., President and Chief Executive Officer of The California Endowment (http://www.calendow.org). Initiated with funding from TCE, the project to create Standards was assigned to the CHIA S&CC. Throughout the various phases of the project, the committee continued to seek and receive guidance and leadership from two of TCE’s then staff members Alice Chen, M.D., Health Policy Scholar in Residence, and Jai Lee Wong, Senior Program Officer.
CHIA Standards & Certification Committee members and co-authors The CHIA Standards were co-authored by members of the CHIA S&CC, namely: Chun, A. (co-chair), Nguyen, E. (co-chair), Agger-Gupta, N., Angelelli, C., Green, C., Haffner, L., Mochel, M., Okahara, L., Solis, B., and Tang, G. Formed in September 2000, the S&CC not only included a group of very experienced interpreters, but also counted representatives from several healthcare, community-based and educational organizations whose experience, skills and knowledge are drawn from a variety of fields such as academic, administration, education, interpreting, research and training. (For a list of the organizations represented by the CHIA S&CC members and co-authors, refer to the CHIA California Standards booklet.
Development and Validation Process The Standards document is a testimony to CHIA’s commitment to bring the research and practice fields together. In producing CHIA Standards, the S&CC has based its work on both practice and research as described in the current literature of the various academic fields, as well as in healthcare interpreter training literature. The project began with the review and synthesis of all standards of practice existing at the time on both the national and international levels. Throughout the process, the co-authors remained committed to a collaborative process of public review and on-going feedback. Numerous drafts of the emerging standards were extensively reviewed by CHIA members in all four regional chapters across the state, at the 2001 CHIA Annual Conference, on the CHIA website, and in four focus groups of experienced healthcare interpreters (Angelelli, C., 2007). When conducting the focus groups, CHIA purposefully sought the input from interpreters of languages of frequent usage such as Spanish and Chinese as well languages of less frequent usage such as Hmong, in order to reflect the broad spectrum of diversity across the state. (For a detailed report on the results of the focus groups, the readers are directed to Angelelli, C. 2007. Validating Professional Standards and Codes: challenges and opportunities. In INTERPRETING: International Journal of Research and Practice in Interpreting. Volume 8:2 pp.175 -193. )
Debut of CHIA Standards on the national and international scenes The CHIA Standards were introduced to audiences at home and around the world in several public events in the following chronological order:
In addition, in March 2003, an article also appeared in a monthly publication by the American Translators Association (ATA) highlighting the development process of the CHIA Standards, the difference between CHIA Standards and other existing standards, and recommendations for using CHIA Standards. (Nguyen, E., 2003. Introducing the CHIA California Standards for Healthcare Interpreters. The ATA Chronicle, Volume XXXII, Issue Number 3, pp. 29-30. http://www.atanet.org).
CHIA Standards – Unique Contributions to the field of Healthcare Interpreting There is a misperception that the CHIA Standards are “just another rendition” of previously existing standards! This misperception has unfortunately misled numerous potential users into disregarding innovative concepts, critical information, and tools that could have been useful to individuals or organizations seeking additional ways to improve their interpreter services. In fact, “The [CHIA] Standards document breaks new ground in its theoretical grounding in medical ethics, the use of an ethical decision-making model to resolve ethical dilemmas faced by interpreters, the guidance provided on four common medical interpreting roles, and in the extensive feedback process for validating the Standards by interpreters across California” (Excerpt from the collection of selected papers published in The Critical Link 4: Professionalization of Interpreting in the Community. 2007.) CHIA acknowledges the pioneering work done by groups such as the Massachusetts Medical Interpreting Association (now IMIA), the Working Group of Minnesota Interpreter Standards Advisory Committee, and the Cross Cultural Health Care Program in Seattle, Washington, which has served as an invaluable inspiration and catalyst for the development process of the CHIA Standards. In creating the document, the CHIA S&CC drew from the strengths of existing standards and sought to address some of the ambiguities that have arisen. These ambiguities were perceived in relation to some of the “gray areas” around the application of the ethical principles and the roles of the healthcare interpreters. CHIA Standards brought some unique contributions to the field by offering practical tools to address some of the ambiguities in question. For example:
CHIA Standards - A stand in favor of “Patient Advocacy” CHIA did not take a prescriptive approach in defining the multiple roles of the healthcare interpreter. Instead, we surveyed the current research and theory on the field of Interpreting Studies, and took a descriptive approach. Research shows unequivocally that the healthcare interpreter role is highly complex. CHIA acknowledged that complexity by showing a continuum of possibilities. Raising awareness and problematizing the notion of "patient advocate" is a unique contribution made by CHIA. By describing the patient advocate role, its limitations, and the potential risks and benefits, CHIA took a stand in favor of the interpreters entering into “patient advocacy” in order to “actively support change in the interest of the patient’s health and well being”. CHIA recognizes that, given the backdrop of disparities stemming from cultural, linguistic, systemic and other barriers often encountered by LEP patients, “interpreters are often the only individuals in a position to identify a problem and to make an attempt to advocate on behalf of a particular patient.” It is imperative then, to provide interpreters with clear guidelines on how to fulfill such a challenging role without jeopardizing the triadic relationship between the patient, provider and interpreter, endangering the well being and safety of the patient, or destroying the credibility of the interpreter. Yet, CHIA also continues to caution interpreters to consider the role of patient advocate as an “optional role” in light of the high level of specialized skills required and the potential risks involved.
Successful Applications of CHIA Standards In creating Standards, the CHIA S&CC envisioned that the document “will serve as a reference for all interpreters; that it will be the basis for the development of job descriptions, performance evaluations, and organizational policies and procedures that will ultimately contribute to quality control; and that it will also form the foundation for training curricula and the basis for the development of tests for CA state accreditation, certification or licensure of healthcare interpreters”. The following highlights ways in which various public and private entities and organizations, as well as one of CHIA’s counterparts, have endorsed or integrated CHIA Standards into their activities, policies, programs or official statements and documents in the past five years:
Expanding training on CHIA Standards CHIA is grateful to continue receiving funding from TCE as well as from the Amgen Foundation to support our educational program around CHIA Standards. The CHIA Education Committee is in the process of creating several training pieces that can be disseminated to various audiences across the state through our local chapters. Our target audiences are: Interpreters, health care providers and administrators at health care facilities. |