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					   Advisory Committee on Qualifications for Health Care Translators and Interpreters

                                         Meeting Site:
                             Health and Human Services Commission
                                  Brown Heatly Building, Room 4530
                                          4900 N. Lamar
                                        Austin, Texas 78751

                                          July 20, 2012
                                         Meeting Minutes

Members in Attendance:                              Members Not in Attendance
Zee Broussard                                       Irma Rubio
Jacque Burandt                                      Leonard Sepeda
Gel Detrick
Esther Diaz
Ryan Foley
Miguel A. Fuentes
Tony Martin
Nancy Miller
Detra Stewart
Fabio Torres

Non-voting Members in Attendance:
Patricia Hosey, Department of State Health Services (DSHS)
Randi Turner, Department of Assistive and Rehabilitative Services (DARS)
Jonathan Cole, Department of Aging and Disability Services

Non-voting Members Not in Attendance:
Laura Jourdan, Health and Human Services Commission (HHSC)
Joan Miller, Department of Family Protective Services (DFPS)


1. Call to order

The meeting was called to order at 10:05 by Esther Diaz.

2. Approval of minutes for the May 25, 2012 meeting (vote required)

Approved as amended.

3. Report on action items from the May 25, 2012 meeting

Esther, Zee and Randi: Flier and Power Point: will create a flier containing the Recommendations,
Qualifications and committee website address and Power Point presentation to go with any poster
presentation the committee may be able to make at each of these events.
Status: Complete.
Discussion:
Randi Turner passed out the fliers that she created. She will make a change to the next edition
omitting the section about translators for sign language. She can mail out hard copies to the committee
members if they need some.


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Jacque distributed fliers out at the Promotora Conference, but was not able to make a presentation
explaining the fliers. The feedback she received was that the fliers didn’t make much sense on their
own without explanation. The flier was also only in English.
Jacque and Esther distributed the fliers at the NCIHC conference in Madison, Wisconsin. They
received feedback from a sign language interpreter who read the flier and saw the section about
translators. The sign language interpreter stated that there is not translation in sign language. Esther
clarified that section to the interpreter. To avoid this in the future, Esther recommended that the
committee modify that qualification to just strike out translator and only include interpreter on the sign
language side. This will be included with a presentation or poster presentation.

Esther, Jacque and Randi: Quick reference card: will create and print a quick reference card
containing the Recommendations, Qualifications and committee website address. These will be
available for the various events listed.
Status: Pending.
Discussion: The new website was not ready in time. When it is, Esther will create the cards.

Esther: Send the fliers, Power Point and cards to the other committee members who will be attending
different events.
Status: Done.

Zee: Submit a proposal to present to the National Healthcare for the Homeless meeting in Washington,
D.C. on March 14, 2013.
Status: In progress.

Jacque: Submit a proposal to present at the San Antonio Health Literacy, “High Tech, High Touch”
meeting in San Antonio on October 5, 2012.
Status: Complete
Discussion: The agenda for the conference has already been set, so there is no time do a formal
presentation. Esther is still able to submit a request to do a poster presentation. If approved, Esther will
do the presentation and distribute the committee fliers and the quick reference cards. Registration is
still open online.

Jacque: Try to do a poster presentation at the Promotora and Community Health Workers Conference
at Christus Santa Rosa in San Antonio on June 8, 2012.
Status: Not able to do the poster presentation but did distribute the fliers.
Discussion: Promotoras are community health workers. They are not necessarily bilingual. They work
all over the state. Persons who are deaf can apply to be a promotora.
Bilingual promotoras do a lot of interpreting. The problem is that they are not subject to the
qualifications because they are not called interpreters. This is an opportunity to talk to this group
because they have a huge role in interpreting. There is a need to connect with them. Dr. Fernando
Martinez runs the Community Health Worker Certificate Program, at Northwest Vista College. It is a
160-hour program. Jacque will try to get an appointment with him to discuss the work of the committee.
The Promotora Program is part of the Department of State Health Services and has provisions for
certification. It is a challenge for the Promotoras in more remote areas to get the trainings required for
certification and recertification. Options such as e-learning can be considered.
Ryan: Suggested using action words, such as “those who perform interpreting”, in the
recommendations. That will broaden the scope of who the recommendations are referring to. At
University Health System, promotoras do internship and serve as patient navigators primarily. They
work in the Care Link program which is the financial assistance program. They are at Christus Santa
Rosa in the emergency care center and physician’s offices as patient navigators. A doctor at the
conference in October will speak about the quantitative value and the statistics that show the effect
these workers have had on health outcomes in the community.


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Randi suggested that Vocational Rehabilitation should look into this opportunity for people who are
deaf.

Esther: Submit a proposal to present at the TAHIT Conference at the San Antonio La Quinta Medical
Center on Sept 7 and 8, 2012.
Status: Done
Discussion: The proposal has been accepted. Esther then showed the committee the conference flier
on the TAHIT website.
Texas Association of Healthcare Interpreters and Translators - Home

Tony: Take the poster and fliers to the Golden Triangle Interpreters Meeting and Election of Officers at
the Ben J. Rogers Visitors Center outside of Beaumont on June 9, 2012.
Status: Done

Esther: Submit a proposal to present at the Quality Healthcare for Diverse Populations meeting in
Oakland, California in March 2013.
Status: Done.
Discussion: Esther is waiting for approval.

Esther and Jacque: Attend the NCIHC Conference in Madison, Wisconsin on May 31-June 1 and
distribute fliers.
Status: Done
Discussion: They received information about what is being done at the national level regarding
healthcare interpreter certification. There was a presentation concerning vicarious trauma for
interpreters. Jacque distributed the written documentation she gathered at the conference. Amy Wilson
Strong did a presentation. She used to be with the Joint Commission and helped draft the criteria
being followed now. She conducted a round table discussion on what the Joint Commission is looking
for. There was also a breakout session on languages of lesser diffusion. NCIHC will have a meeting
next year in Seattle.

Zee: Send the Alabama training program to Esther
Status: In progress
Discussion: Zee will scan the Table of Contents and send to Esther.

All: Send Esther any links to healthcare training sites
Status: Done

Nancy and Irma: Submit a proposal to present at the Annual Nursing Leadership Conference on
September 21-22, 2012.
Status: In progress.
Discussion: The agenda is already set. Nancy is negotiating an opportunity to distribute the
committee information at the conference. She will ask if there is an opportunity for a poster
presentation, and if not, if we could put the committee information in the conference packets. There is
a monthly Texas Nurses Association District 5 meeting on Tuesday nights. Nancy will try to get on an
agenda and Esther said she could do a presentation.

Tony: Will work on definitions for the committee website.
Status: In progress.

Esther: Post a link to the “Getting It Right” brochure on the American Translators Association site,
ATANET.org, on the committee website.
Status: Done


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Zee: Speak to a contact on whether the training for sign language interpreters in healthcare includes
translation in the interpreting context.
Status: Done
Discussion: Zee spoke to Dr. Chris Mooreland and he said no, there is no translation from English to
American Sign Language (ASL).
Todd Agan leans towards yes, there can be translation from English to ASL from what he has seen out
of the CATIE Institute based on the Medicine and the Law DVD.
Pauline Wood, a retired teacher in Louisiana, said no, it’s impossible to translate. Other deaf educators
Zee has spoken to say no.
Esther recommended that the committee not include translation for sign language in the qualifications.
In the general qualifications for spoken language there will be a requirement to write a short, simple
translation. CCHI includes questions about written translation.

Ryan: Speak to the manager of the Masterword Translation Unit about creating a checklist on what
makes up a quality translation, what to look for in a translator and the process for proofreading a
translated document.
Status: Done
Discussion: Ryan will present later in the meeting.

Detra: Set up a time to speak with Esther and Jo Westbury to discuss the committee’s work and get
any feedback from the interpreter and translator community that Ms. Westbury may have.
Status: Not done
Discussion: Esther did get an invitation to speak during Ms. Westbury’s presentation at the TSID
meeting in Austin. Esther used the questions that came up in the previous year’s TSID meeting in
Corpus Christi, along with new information, to speak from. At this meeting, she did not get any
questions.

Zee reported that Visual Communication Services (VCS) out of Houston will be hosting a medical
workshop in San Antonio and Houston on August 17 and 18, 2012. Zee will give a short presentation
on the work of the committee via video. Detra will speak about the advocacy work that she does.
There will also be a presentation on getting HIPAA certified.

Paula: Add to next agenda a committee vote on what recommendation should be made to the HHSC
Executive Commissioner before the next Legislative Session.
Status: Done

All: Discuss a possible recommendation regarding patient liaisons in hospitals serving international
patients and possible conflicts of interest.
Status: Esther did get information and shared with Ryan.
Discussion: Esther emailed Graciela Zozaya, who has been a patient representative in a hospital for
many years. Ms. Zozaya recommended coming up with a process for good translations. She explained
the role of patient liaison versus interpreter.

Patient liaisons or patient representatives work in hospitals and make sure the patients get the care
they need. They help patients when they have problems with the staff or if they need additional
services. They can sometimes serve as interpreters. The issue is separating those two roles. Ms.
Zozaya sent Esther some comments and suggestions:
         Refrain from advocating when interpreting. State your role clearly to the patient and provider.
         During the interpretive session, if an issue arises that should be addressed by the worker in
            their liaison role, inform the patient and provider that the issue will be addressed once the
            interpreter services are no longer needed.
         During care conferences or family meetings when there is a need for the liaison role and
            language assistance is needed for the rest of the group, the advocate should request the
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          services of another interpreter and inform the rest of the group that he or she will not be
          interpreting. One role at a time.
        An advocate should take care not to disclose private health information about a patient that
          is gained during interpreted sessions.
        When in a dual role, the interpreter should be very clear about both of his or her roles and
          make sure the other people know at all times when he or she is acting as one or the other to
          avoid confusion.
Does the committee want to include these as a recommendation or best practice?

Gel: Medicaid does not pay for patient advocate services. Medicaid and Medicare will pay for
interpreter services in very specific cases. Payment is through the health plan, not through the hospital.
Randi: HHSC Medicaid can give a partial reimbursement for doctors for sign language interpreters.
Esther: In Texas there is a capitation rate for Medicaid that includes all services to the patients.
Interpreting is considered part of that service. Medicaid does not reimburse all of that service; that is a
cost that the hospital and providers have to absorb.

4. Report from subcommittees

Website Subcommittee: http://rith.info/

Esther displayed and discussed the committee’s external website.
The additional website allows the committee to link to sites that would not be appropriate for the HHSC
website. The RITH website will be used to link to sites such as private vendors that provide training or
organizations that may have political leanings. It is a resource where healthcare interpreters and their
administrators can go for help. It’s also a way to get the current and any new recommendations out the
public, even if they don’t become law.

The FAQ section will include the questions that Esther answered at TSID. There may need to be a
FAQ subcommittee. The glossary section will include the definitions. Certification exams need to be
added to the website. The website will be maintained by Tony’s students. He will need to find a student
who is proficient in programming.

Definitions Subcommittee:

Tony will send the current definitions to the committee members to review. Each member will review
the list and mark the terms that they disagree with. These terms will be discussed at the next meeting.

5. Discussion on standards for translation quality

Ryan Foley gave a presentation explaining the process and checklists MasterWord developed for
translations. The checklist is proprietary to MasterWord.

 Esther: Maybe the committee should come up with recommendations for hospitals, clinics and
providers to use when they need translations of healthcare documents, either from an in-house source
or from an outside translation service. There is some information at the American Translators
Association website in their “Getting It Right” brochure.

Esther presented her draft translation quality recommendations:

A request for translation should include the following information:
        Function, overall purpose and end use of the source text
        Description of target audience for translated text – literacy level, cultural concepts, regional
          language variations
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        Specific needs and special requirements, such as adaptation for low literacy level or specific
         terminology preferences.

The translator should meet the following qualifications:
        Formal education in the target language
        Ability to read and write in the source language
        Knowledge and experience with the culture of the intended audience
        Relevant health background

The translation should be reviewed and edited with the following criteria in mind:
        Reliability – meaning of original text is clearly conveyed in new language
        Completeness – nothing is omitted or added to the original message
        Accuracy – text is free of spelling and grammatical errors
        Cultural appropriateness – message is meaningful and appropriate for the target culture

Comments:
Zee: Good indication of what needs to be done.
Miguel: This is good for high level or general level translations. In a hospital setting, usually a doctor
explains the consent form to a patient rather than have the patient read the consent form. Many times
the patient just signs the form. Accurate translation of discharge instructions is very important. The
hospital Risk Management office said that the hospital has to comply with the Joint Commission and
that means the hospital must pay for translation. Miguel chose an agency for his hospital to send all
documents that need translation through. One issue is that the more the cost, the more difficult it is to
get the hospital to approve the expense.
Ryan: Add “reviewed by a working editor” under “The translation should be reviewed and edited with
the following criteria.” This function can be outsourced. To help with the cost to the hospital, an
outsourced company can translate standard consent forms and each department can pay for a form to
be translated into one language. Then the departments can share documents.
Nancy: The recommendations should include that the translation should be done by more than one
person.

Esther: The committee should recommend as a best practice that hospitals and individual providers
need to send translations to an agency instead of doing the translation in-house. Here are options:
         Outsource: company that specializes in healthcare and has good references.
         In-house: Individual translators and editors need to be qualified, and there must be a
          process that ensures quality.

There may be a need for a separate recommendation for out-sourcing. Ryan will come up with some
draft wording for this recommendation.

Esther: The committee’s target audience is hospitals and individual providers. They will have to pick up
the cost of outsourcing. For those that do not choose to outsource, they need to know what it takes to
produce a quality translation and see if they are able to do it in-house.

Detra: In general, we can recommend that hospitals and individual providers go through a qualified
agency, and cost should not be a concern of the committee. Cost can always be used as an excuse to
not provide interpreter and translator services, but the law requires effective communication for people
with LEP and disabilities.

Ryan: Maybe the committee shouldn’t just recommend using an agency, but rather focus on a
mechanism. An agency can provide that mechanism or process. Once a hospital is informed on what
the mechanism or process requires, the hospital will probably realize that it is more cost effective to
use an agency over in-house. That gives hospitals and providers a choice.
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Ryan and Fabio work with agencies. Ryan will talk about what qualifications MasterWord looks for in
their translators, editors, proofreader and formatter at the next meeting.

Jacque: Read from the Joint Commission’s “Insure the Competency of Individuals Providing Language
Services.” She suggested using that wording.

6. Public Comment

Ira Sangupta:
In Washington State, there is a conflict between interpreters and patient guides. There is not enough
money for both services. A training program was created to teach interpreters to be patient guides,
along with being the staff interpreter. The Affordable Care Act clearly defines where community health
workers and patient guides should be used.

Washington State has dealt extensively with workers and there are 24 medical glossaries. One thing
they tell systems to do is to have a community advisory board to look at this and there has to be a
process of back-translation on editing work. The issue is risk management and liability. A hospital
needs to consider this. The committee should give providers a robust policy or protocol.

Hospitals have to abide by the CLAS Standards from the Joint Commission. Some hospitals also work
with DNV (Det Norske Veritas) to help. DNV is a provider from Europe that helps businesses manage
risk. They assist hospitals meet regulatory standards. DNV has a “partnership approach” with hospital
systems.

Lastly, communicate with the legislature!

Esther: The American Society for Testing and Materials has standards for interpretation quality and
translation quality. The standards for translation quality involve a process.


7. Discussion on recommendations to be made to the Executive Commissioner before the next
Legislative Session. (vote required)

This year, the new work of the committee is the recommended qualifications for interpreters and the
training requirements for interpreters.

Motion: Zee moved that the committee moves to submit the recommendations to the Executive
Commissioner before the next legislative session.

Seconded by Ryan.

Vote was unanimous and the motion passed.

The next meeting will be spent refining the language of what will be submitted to the HHSC Executive
Commissioner.


8. Discussion of expiration of member terms and officer election requirements.

The committee will make nominations for the next Chair and Vice-chair at the September meeting and
vote on the nominees at the November meeting.


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Each of the members whose term ends December 31, 2012 have agreed to remain on the committee
for another 3 year term. Paula will send an email request for confirmation to each of these members.

9. Discussion of Goals, Work Plan, and Schedule for Next Meeting


Possible Recommendation additions or edits:

Do not include a section regarding translation in the sign language qualifications.

Outsource translations, and if not, hospitals and doctors need a type of quality assurance tool when
they are using in-house resources for translations to insure quality.

The process for quality translations needs to include being reviewed by more than one person.

Suggestion: Use action words such as, “those who perform interpreting.”

The next meeting will include refining the language for any additions or edits to the
recommendations.


ACTION ITEMS for next meeting

1. Esther: Will submit a proposal to do a poster presentation at the San Antonio Health Literacy
conference in San Antonio on October 5, 2012. If approved, Esther will do the present the poster at the
conference.

2. Randi: Will change the flier she created to omit the language regarding a “translator” for sign under
experience.

3. Jacque: Will connect Esther with Dr. Fernando Martinez from the public health worker program at
Northwest Vista College to discuss Promotoras regarding training and recertification.

4. Esther and Paula: Esther will send the TAHIT brochure to Paula to distribute.

5. Zee: Will scan the Table of Contents of the Alabama Training Program and send to Esther.

6. Zee: Visual Communication Services is hosting a medical workshop on Aug. 17 in San Antonio and
Houston. Zee will attend via video to answer questions. There will be a presentation on HIPAA training
for certification. Zee will email the dates and locations to Esther and Paula.

7. Nancy: Look for opportunities to distribute the committee’s information at the Annual Leadership
Conference on Sept. 21-22. There are District 5 Texas Nurses Association meetings on Tuesday
nights. Nancy has a scheduling conflict, so Esther is available to present the committee’s information, if
needed.

8. Tony: Will distribute the definitions in a Word document to the committee for review before the
September meeting.

9. All: Review the definitions. Please determine what words or definitions you disagree with and be
ready to discuss at the September meeting.

10. Esther or Tony: Sites for certification exams need to be added to the committee’s RITH website.

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11. Tony: will look into what is needed to run the RITH website and if he has the resources.

12. Ryan: Draft translation qualifications for selecting a translation provider or outsourcing. Fabio will
help.

13. Paula: Will send a formal note regarding another term to the committee members whose terms are
expiring.


Next Meeting Date and Location

September 28, 2012
Winters Public Hearing Room
701 West 51st
Austin, Texas 78751

November 30, 2012
Brown Heatly Building, room 4501
4900 N. Lamar
Austin, Texas 78751

Any changes to the meeting schedule will be announced on the committee website.

10. Adjourn




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