Interpreters for the Community

The MAMI Model and Suggestions for NY State

Cornelia E. Brown, Ph.D.

Our “Innovation”

I was drawn into community service from the Ivory Tower

Founding Director of the non-profit: Multicultural Association of Medical Interpreters [“MAMI”] of CNY

Located in Utica (60,000 on Erie Canal) “When in trouble, call….”

Overview of Talk

Review of MAMI How it works What it does What elements reproducible

Make suggestions for NYS policy Based on MAMI model and experiences

How to Create Language Access around the State? LEP in NY scattered over whole state* 300,000 – 500,000 Upstate My focus – helping area-wide

Not in-house service All around community

smaller cities enclaves in large cities City/country: all live in a community

1996 in Oneida County: LEP Language Barrier 20k immigrants, 10% of County Dearth trained interpreters (clinic>court) Friends, family, untrained employees,

passers-by, gesture used for access Bilingual case-management from

resettlement agency (gov’t funded) “It was a big problem, especially w/feelings

because you feel helpless everywhere.”

November 1996 Utica, NY

Public health Clinic (TB control) acted on need for trained medical interpreters [MI]: 10-hour course funded by NYSDOH

30 bilingual, volunteer MI gather to train We learned that 1964 Civil Rights Law

requires use of trained interpreters for LEP patients

The Urgency We Felt

Shared horror stories: health care with poor communication across system No Patient self-determination: elderly Chinese

man “signs” form (dentist) No Confidentiality: church friend interprets for

mental health visit (mental health) Hidden conflict of interest: DV victim Culture bumps: Vietnamese father (HD)

First Steps

Start a service to help patient and provider understand each other?

Volunteer community interpreters met monthly over 1997

Hospitals, insurers, child protective, perinatal, health dept, nurses, college teachers join

Could We Train Interpreters Locally and Make Them Available to All? Training interpreters costs money! Who will want to take a long training if there’s

no paid work? Even if some people train, what’s to keep

them available? Where to house the service? Who pays?

Interpreter-Training Easiest Part

Received start-up funds for training NY Task Force for Immigrant Health 1998

Train-the-trainer for continuity Trained 17 interpreters in 4 languages

No host organization found as of June 1998

Choice Made -- Fall 1998

Recruited Board of existing partners Hoped for support from fees for skilled

services: interpreting, translating, training Chose “multicultural” name of MAMI Started an independent 501©3 corporation No income yet

Thumbnail History (1)

August ’99 dispatched first paid MI services, echoing office, 2 paid staff, 20 appts/mo.

MMIA Certification Committee made us written, oral exams, internship ’99-2000

2000 SCORE Small Business of the Year Basic Medical Interpreting 2x/year

Thumbnail History (2)

2001: 200 appointments/month 2002-2003 Legal interpreting course (DV) 2004-2005 Mental health course 2004: On-site 24/7 service 2006: Syracuse hospitals choose MAMI.

Open SYR branch office (50 miles west).

Thumbnail History (3)

December 2006: 900 appointments/mo. (Utica) and 20 (Syracuse)

Hired Coordinator Legal Interpreting Teach 20th course Medical Interpreting April ’07: 9 office staff, 8 MI staff, 65

independent contractor-MI in 28 languages. Only agency w/MI throughout CNY

Changing Context: Expanded LEP Services Utica 2007 Interpreting agency explosion

Resettlement agency: trained fee-based MI Small “agencies”: ad hoc, fee-based MI

More interpreters available Most trained interpreters: hospitals Still need MI: small doctor’s (Medicaid), DSS,

jobs service, police, corrections, courts, schools

Why the Improvement?

More hospital regulations Attorney General Decisions NYS DOH Law JCAHO regulations

NCIHC Ethics and standards CLAS standards Providers start seeing patient viewpoint

MAMI Services

Skilled on-site medical / legal interpreting Written translation Interpreter training (medical, legal, mental

health, train-the-trainer apprenticeship) Provider cultural competency Advocacy Labor-readiness: Driving ESL, nursing home

Dangers of Being Rural/ Suburban and Independent Lower quality standards Isolation: powerless and unawares Unqualified personnel and poor access to

new technologies

Meeting the Challenge:Model for Success Economic Self-sufficiency Community roots (refugees, providers) Skilled services

Self-sustaining (1): Overall

95% supported by fee-for-service Despite competition w/free services

Quality of service draws customers Interpreters paid not volunteer ($14.50-$23 Survives on gap between cost and fees

Grants only for start-up agency or new projects, e.g. 24/7 self-sufficient after 4 months.

Self-sustaining (2): Basic Medical Interpreting Course Cost of 72-hour course, internship, oral

Certificate exam: $575 Some scholarships available Total of 20 courses taught Completed by about 200 individuals Self-funding gives MAMI flexibility

Community Roots (1)

MAMI reaches out to LEP Patients On-site interpretation core of caring Patients visit office w/interpreting requests

1/3 of appointment requests initially from patients Patients visit office w/advocacy requests

Calling the prison Patients ask MAMI for special courses: e.g.

driving-ESL

Community Roots (2)

MAMI reaches out to interpreters MAMI Alumni Association Presentations: “Can My 7-year-Old Interpret

for Me in Emergency Room?” Advocacy:

Organize LEP forums Publish in newspapers Publicize right to interpreter services

Community Roots (3)

MAMI Reaches out to providers Help Design and teach interpreter course Mutual learning process

DA, Judges, lawyers, police, victims services helped w/legal interpreting course (40 hr)

Mental health providers helped w/mental health interpreting course (40 hr)

Hospice added to basic medical course Develop joint protocols; umbrella fees

Skilled: Foremost Interpreter Training Program in Upstate New York Medical Interpreting

72-hour course, NCIHC standards. 6-mo. paid internship, then Oral exam MAMI (in-house) Certificate (MMIA pilot)

Interpreting for DV/SV Victims, Police/Courts (40 hrs)

Interpreting for Mental Health (40 hrs)

Skilled: State and National Contacts

Statewide partners: Perinatal network, Family Planning Advocates, Voices

Since 1998 member Massachusetts Medical Interpreter Association

Since 1998 on board of National Council on Interpreting in Healthcare

Skilled: New Technologies

Multilingual voice mail (language access for MV Perinatal Network)

Web-based interpreter dispatch and billing system (provider ease-of-access)

Two-tiered interpreting program: on-site default with video back-up (hospital partners)

Skilled: Testimonials

CPS Social worker “For psych eval, sigh of relief if it’s at City Court because MAMI has a contract”

Head of Patient services large mental health clinic: “I don’t work for MAMI. Use them constantly. MAMI interpreters clearly superior to untrained, and to the less-well trained.”

Generalized “MAMI”/ Community Model for Interpreting Services Self-sustaining center for training/dispatch Used by all local health care facilities

Sharing of interpreting costs Holistic*: sharing protocols, provider training,

MI and provider regular meetings Beyond medical: legal too Credential and income stays at home

MAMI/ Community Model Makes Trained On-site Available Facilitate communication & understanding Retain the visual: body language, check for

understanding Easier to intervene to clarify*, broker cultures Lobby to registration desk Especially needed: mental health, child,

elderly or deaf, teaching session, group, regional dialect, complex situations

Why on-site: Visibility Key to Understanding Technical and Health Committee of the

International Association of Conference Interpreters (2004):

Interpreters need the visual just like actors who “must be able to tell that the message is getting across. Without this feedback, interpretation runs the risk of becoming mechanical and the quality goes down automatically.”

Remote as Back-up; Can Be Local Too Crucial part of fully-functioning system Circumstances: emergency, unusual

language, what normally done on telephone, back-up availability

Many types. Video preserves visual. Remote can be offered locally by cadre of on-

site MI: economy and continuity of care

Policy Recommendations (1)

(1) Funding language access Ensure that publicly-funded agencies offer

trained interpreting only. Don’t create preference for remote over on-

site. Patient understanding is key. Fund interpreter recruitment. Bilinguals don’t

fill whole need for language access.

Policy Recommendations (2)

(2) Enforcement, Interpreter Competency NCIHC Standards of Practice/ Ethics

NYS AG Settlements with Hospitals MA Office of Minority Health Best Practices

Enforcement at all health facilities: small doctor’s offices, Medicaid clinics

Enforcement at government sites: DSS, corrections, CPS, drugs

Policy Recommendations (3a)

(3) Workforce Development Statewide clearing house. RFP for

translations. LLD done locally w/community back-translation.

To identify promising practices: collaborative of stakeholders. Upstate and Downstate meet separately and together.

Policy Recommendations (3b)

Establish MI training & dispatch centers throughout state Develop local capacity for medical and legal

interpreting Self-sufficient, community cost-sharing for

economies of scale. High-need areas all over state. Don’t forget

migrants.

Policy Recommendations (3c)

Precedents for local training centers AHEC in Massachusetts, Virginia, FloridaAHEC in Massachusetts, Virginia, Florida Texas training/dispatch centersTexas training/dispatch centers Philadelphia “global” programPhiladelphia “global” program

Why?Why? MI needed everywhere not just in hospitalsMI needed everywhere not just in hospitals Reduce healthcare cost for all.Reduce healthcare cost for all. Income stays in state and helps economyIncome stays in state and helps economy Once refugee, trained MI gives back to all.Once refugee, trained MI gives back to all.

Conclusion “When In trouble…”

In the rush to high-tech, don’t forget the human and immediate

Lyuba: “Before MAMI, it was a big problem, especially w/feelings, because you feel helpless everywhere. Now, I’m glad there’s help, she said, lowering her bright green eyes to a notebook sitting on a desk in the MAMI office. Because I was in their place too.”