Overview of Key Developments in NCIHC History

1994 - 1995 - 1997 - 1998 - 1999 - 2000 - 2001 - 2002

Background

During the past several decades, the influx of immigrants and refugees into the United States has added significantly to the limited-English-speaking population in this country.

Language and cultural differences between these groups and English-speaking institutions was causing great concern in some sectors about the quality of service being received by limited-English-speaking clients and led to innovative programs in several areas of the country to provide interpreting services to those clients. These initial efforts, resulting in programs in such places as Boston (MA), Minneapolis (MN), Stanford (CA), and Seattle (WA) were led by pioneering individuals who, though sporadically in contact with each other, were largely working alone on a local level.

By 1994, there was a growing desire among leaders of these programs to establish closer ties with others in the field of medical and social service interpreting, with the goal of establishing a national dialogue around issues of role, standards, training and certification. The Cross Cultural Health Care Program of Seattle secured a small grant from the W.K. Kellogg Foundation to fund a short working conference to address these concerns in June 1994.

1994 - Medical Interpreting: A Working Conference

This two-day mini-conference took place on June 10-11, 1994 in Seattle and was organized jointly by the Cross Cultural Health Care Program and the Society of Medical Interpreters, also of Seattle. 

The conference was designed to meet several goals:

1. to clarify the issues involved in improving interpreting services in health care settings;

2. to share experiences with and approaches to interpreting and the training of interpreters;

3. to lay the groundwork for the establishment of national standards of practice for medical interpreters;

4. to set an agenda for national debate around medical interpreter issues.

There were 28 participants in the conference, 11 of whom came from outside Washington State, and two of whom came from Manitoba, Canada. They represented medical interpreters, program planners, trainers, and health care providers, all of whom had experience in the field of medical interpreting.

Interpreters of many languages participated, including Haitian Creole, Amharic, Hindi/Bengali, Spanish, Cambodian, Vietnamese and Cree. While the original program included discussion of interpreter roles, legislation and litigation, establishing competencies, and the needs of small language groups, it soon became clear that the role of the interpreter was an issue of such apparent disagreement that it became the central focus of the conference.

After two days, the participants were in clear agreement on only one thing: the need to continue the dialogue in a formal way and to continue to work together. The group dubbed itself the “National Working Group,” outlined an agenda for discussion and research, and tentatively scheduled a follow-up meeting for October 1994 in Boston (pending funding), under the auspices of the Massachusetts Medical Interpreters Association (MMIA).

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1995 -The Next Step for the Working Group: Meeting in Toronto

Unfortunately, the Working Group’s efforts to secure funding for its next meeting were unsuccessful. An offer of funding from the Kaiser Family Foundation was declined when it became clear that Kaiser wished the next conference to include representatives from hospital administration and insurance agencies. Many of the members of the Working Group felt it premature to open the debate to these entities when the profession itself could not agree on such basic issues as the interpreter’s role and standards of practice.

In June 1995, however, the First International Conference on Community Interpreting was held in Toronto, Canada. As many of the key participants in the Working Group were able to attend that conference, arrangements were made to stay an extra day at the conference site to continue the group’s work.

This short meeting of the Working Group focused on one task only: the review of a set of Standards of Practice developed by the Massachusetts Medical Interpreters Association and the Education Development Center (EDC) and subsequently published in 1996. It was clear in this meeting that the Working Group meeting a year earlier had had a significant impact on all the participants’ thinking about these crucial issues. While the Working Group made some concrete suggestions for the Standards, there was much more agreement than at the previous meeting.

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Meeting Number Three: Boston 1997

Although the Working Group did not meet in 1996, this was a year of prolific local activity within the field. It was also a year of planning for the Massachusetts Medical Interpreters Association (MMIA), which decided to organize a Conference on Medical Interpreting in Boston for May 1997, to coincide with the next meeting of the Working Group. This meeting of the group was organized by the MMIA with seed money from the Cross Cultural Health Care Program through another grant from the W.K. Kellogg Foundation, and it included a much larger group of participants and observers than previous meetings (about 50).

This time around, the 2 1/2 day conference focused on issues of interpreter roles; the training of interpreters, providers and administrators; standardization and certification; and the future of the Working Group. Participants were guided to more clearly define their differences in how they view interpreter roles, with the hope that the meeting would produce agreement on a set of basic responsibilities. Four clear approaches to role emerged, but no single set of responsibilities was agreed upon. Small groups also discussed the key elements of training, as well as the benefits and dangers in standardization and certification.

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The Working Group Becomes Official: Seattle 1998

The fourth meeting of the Working Group took place for 2 1/2 days in Seattle in May 1998, preceding the Second International Conference on Community Interpreting, which was held in Vancouver, BC. It was sponsored again by the Cross Cultural Health Care Program (with continued support from W.K. Kellogg Foundation) and the Society of Medical Interpreters (SOMI), with contributions from the Education Development Center, Inc. (EDC) in Newton, MA.

The group continued to grow, as the network of those working in this field widened. For the first time, members of the Navajo Nation attended the meeting. The participants once again addressed familiar topics: roles, standards of practice, research and the future of the group. The group also heard from a representative of the National Health Law Project about its recent publication on the legal supports for language access in medical and social service settings, and from the Office for Civil Rights about the recent draft Guidance Memorandum released from the national office in February 1998.

The group reached a much higher consensus than in previous years, especially around the topic of role. In addition, participants once again reviewed the MMIA’s Standards of Practice and agreed to endorse the document as the best explication of standards for medical interpreters available at that time.

Finally, the group decided to formalize itself to a greater degree. The name “National Council on Interpretation in Health Care” (later changed to the “National Council on Interpreting in Health Care”) was chosen and two ad hoc committees were formed; one to establish contact with the committee of the Association for Standards and Training Materials (ASTM) that was working drafting standards for interpreter use in the U.S., and one to meet with the U.S. DHHS Office for Civil Rights to give feedback on the recently released draft guidance memorandum on language access.

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What happened next? The Interim Executive Committee

Once the Council had a name, it needed a structure. In order to formulate a proposed organizational structure to present at the 1999 meeting, everyone who had attended two or more of the Council’s four meetings was invited to vote for five candidates.

The five elected individuals joined with Cindy Roat and Bob Putsch of the Cross Cultural Health Care Program and Maria Paz Avery of the EDC (all three of whom had been doing much of the organizational legwork on previous meetings), to form an Interim Executive Committee. This committee met by conference call during late 1998 to develop an organizational structure to be considered at the next meeting of the NCIHC.

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1999: The NCIHC at Monterey

In the meanwhile, a seed grant from the AT&T Language Line (now Language Line Services) allowed the NCIHC to reserve space at the Asilomar Conference Center in Monterey, CA as the site for the 1999 annual meeting. Held on June 4-6, this meeting was attended by 50 key individuals from around the country. The discussion focused on standards, training and testing of medical interpreters, as well as providing opportunities for networking. Participants heard updates on legislation effecting language access and a report on new research being done in the field. They also had the chance to meet with Ira Pollack of the Region IX Office for Civil Rights to provide input on the revisions to the OCR Guidance Memorandum.

A major step for the organization took place at this meeting as well. The administrative structure proposed by the Interim Executive Committee was presented, debated, revised and accepted, and a 13-member Board of Directors was elected. That Board now had the task of forming and growing the organization, defining its work, reaching out to potential members, and producing position papers relevant to medical interpretation. The Council was on the verge of becoming a reality.

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1999 - 2000: Becoming a “Real” Organization

The year between the meeting in Monterey and the meeting in June 2000 in Madison, Wisconsin, was a busy one as the Board set out to build the Council into a functioning organization. The committees began to recruit members and establish agendas, but it soon became clear that the work of the Council was going to require funding.

During those twelve months, the work of the Council was supported by several grants. One, from the California Endowment through Stanford Medical Center, was targeted at making possible the year 2000 meeting of the group, which was scheduled for June in Madison, Wisconsin, through the hard work of Shiva Bidar Sielaff and with support from the University of Wisconsin Hospital and Clinics.

A second source of support was the Illinois Department of Public Aid through the Jewish Federation of Chicago and focused on facilitating conference calls and small group meetings of the Council committees for 2000-2001, as well as on printing and disseminating the work produced by the committees and the maintenance of the NCIHC listserv.

The third source of support was the Office of Minority Health through the Centers for the Advancement of Health, which helped pay for board conference calls, the creation of a website and, most importantly, the contracting of a Program Coordinator.

Other accomplishments for that year included: the first steps in the creation of by-laws; production of a brochure; expansion of the NCIHC listserv; and the beginning of an annotated bibliography of research related to medical interpreting. The Council also made a presentation at the national conference of the American Translator’s Association in November and had several abstracts accepted for the Critical Link International Conference on Community Interpreting scheduled for May 2001. Two formal letters of comment were sent to the Office for Civil Rights referent to the proposed revisions to the 1999 Guidance Memorandum. And last, but certainly not least, the annual meeting was planned for June 2000 in Madison.

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Madison in June 2000

The Sixth Meeting of the NCIHC took place at the Friedrick Center in Madison, Wisconsin, and was facilitated by Patricia Ohmans of Minneapolis. The 50 participants came from 17 states plus the Navajo Nation and represented interpreters, trainers, administrators, medical providers, policy analysts, and legal experts. The agenda was split between administrative business of the Council and programmatic topics. Each committee gave an update on its work, and there were updates as well on recent research, policy issues, program development, certification and interpreter assessment. The group had a chance to give input to each committee, which led to the setting of committee agendas for the next year.

At the end of this meeting more than any other, individuals left with a clear idea of the work before them. The Standards and Training Committee committed itself to producing four position papers on topics such as screening guidelines and standards for training programs. The Policy and Research Committee agreed to produce an annotated bibliography of research related to medical interpreting and to provide input to the national Office for Civil Rights and regulatory agencies about the adequate provision of interpreter services. The Organizational Development Committee took on the task of producing by-laws for the Council and establishing it legally, while the Membership and Outreach Committee noted the need to facilitate increased membership in the organization. Clearly, the NCIHC was poised to become a national force in shaping of policy and practice, both within and outside of the medical interpreting profession.

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2000-2001: A Meeting in Austin and Busy Times

This was the year that the NCIHC really started to produce. The Council held its Seventh National Meeting at the University of Texas, sponsored by the Texas Department of Health, DHHS Office of Minority Health, California Endowment, Language Line Services, CTS Language Link and Pacific Interpreters. The July 2001 meeting, hosted by Esther Diaz and Elaine Quinn, was attended by NCIHC board and committee members who heard national updates and focused on the next steps for the development of the NCIHC as an organization.

The following were some of the NCIHC’s accomplishments through June 2001:

• Publication of four position papers: The Role of the Health Care Interpreter: An evolving dialogue, Guide to Initial Assessment of Interpreter Qualifications, The Ethical Involvement of Limited English Speakers in Research, Linguistically Appropriate Access and Services: An Evaluation and Review for Healthcare Organizations

• Publication of a Program Resource Directory for Health Care Interpreters, including Training Programs, Professional Associations and Innovative Service Delivery Programs

• Publication on the website of a bibliography of hard research on language access

• Responses to several national political events: HR 969, the AMA letter to the Secretary of DHHS requesting that OCR’s 2000 Guidance Memorandum not be enforced

• Establishment of a relationship with the American Public Health Association (APHA), the American Hospital Association (AHA), and the American Translators Association (ATA)

• Legal incorporation of the NCIHC, and legal establishment as a not-for-profit organization

• Creation of a website

• Design of a logo

• Election of a new board

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Program Year 2001-2002

The period between June 2001 and June 2002 was a busy one, culminating in an Annual Meeting of Board and Committees held in Chicago, IL, hosted by Wilma Alvarado-Little. During that year, the Council accomplished the following:

• Publication of four position papers: The Terminology of Health Care Interpreting, A Code of Ethics for Health Care Interpreters: A Working Paper for discussion, Models for the Provision of Language Access in Health Care Settings, Models for the Provision of Health Care Interpreter Training

• Drafts developed of three additional papers: a paper on telephone interpreting, a paper on translation and interpreters, a paper on appropriate positioning

• Incorporation in the State of California in December 2001 and recognition by the IRS and the State of California as a non-profit organization in April 2002

• Contract with the DHHS Office of Minority Health to fund a pilot of the MMIA certification process and to build national consensus around the NCIHC Code of Ethics.

• Implementation of a monthly bulletin to improve communication with committees

• Establishment of the Advisory Committee

• Development of internal policies regarding copyright and board ethics

• Development of a membership plan

• Letters sent to: the Department of Health and Human Services referent to its revised LEP guidance memorandum, the Department of Justice referent to its draft LEP guidance memorandum, the Department of Education referent to its lack of even a draft guidance, the AMA regarding a January news release on medical interpreting that was highly inaccurate, the key house and senate committee chairs of the Washington State, Legislature in an effort to support reinstatement of funding for health care interpreting into the 2002-2004 state budget, the Office for the Management of the Budget, regarding the cost of instituting Executive Order 13166

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Conclusion

Since 1994, the National Council on Interpreting in Health Care has grown from a small informal working group to an established national organization that provides multidisciplinary leadership to an emerging field and a united voice on behalf of language access in health care. Through the work of dedicated individuals and the financial support of private and public institutions, the NCIHC is helping to advance the cause of health care interpreting with the goal of improving access to health care for all patients, regardless of their ability to speak English.