Supplements

Additional examples, commentary, and guidance to support the application of the standards of practice.

Principle 1: Accuracy and Completeness

Standard 1.1: Maintain fidelity to the meaning

Additional Context: This standard emphasizes the importance of interpreting all content, even when it may seem redundant, irrelevant, or rude to the interpreter. Fidelity to the message requires separating personal biases from the content, which can be challenging when the substance is difficult, graphic, emotionally laden, or uncomfortable.

Key Principle: Interpreters do not decide to omit or distort messages because they are personally offensive or because they are uncomfortable with the language or content of the message.

Standard 1.2: Include information expressed in formality, style, and tone

Paralinguistic Elements: This standard requires attention to nonverbal elements of communication - the aspects of communication that do not involve words, including tone, pace, and visible expressions.

Mode Considerations:

• Onsite face-to-face interpreters have access to the most inputs and can "read the room"
• Telephonic interpreters have no visual inputs
• Video remote interpreters can see more than telephonic but usually less than face-to-face, depending on the device

Additional Prompt: Have I included the meaning expressed in all the nonverbal elements of the message that are available to me in this mode of interpretation?

Standard 1.3: Ask for clarification

Additional Examples:

• Interpreters ask clinicians to explain medical terms they are unfamiliar with
• When encountering regional variations of the same language, interpreters ask for clarification of terms that may have different meanings in different geographical areas
• Interpreters request clarification for culturally specific terms or concepts that may not have direct equivalents

Standard 1.4: Monitor interpretation for errors

Timing Considerations: When correcting errors, interpreters must assess the best time to intervene to support the goals of the encounter. This involves considering:

• The impact of the error on the meaning or participants' goals
• The appropriate moment to make the correction without disrupting the flow
• How to maintain transparency while minimizing confusion

Additional Prompts:

• What do I need to consider before intervening to correct my error?
• How will this correction support or hinder the participants' communication goals?
• Is this the best moment to address the error?

Standard 1.5: Evaluate participant access

Access Optimization: Interpreters must continuously assess whether they have adequate audio and visual access to provide accurate interpretation, and take steps to improve access when needed.

Standard 1.6: Monitor emotions and biases

Self-Awareness: Interpreters must maintain awareness of their own emotional responses and biases to ensure they don't influence the interpretation, even when they disagree with the speaker's message.

Principle 2: Effective Communication

Standard 2.1: Maintain transparency

Transparency Framework: All participants must clearly understand when the interpreter is speaking for themselves versus conveying someone else's message. This builds trust and ensures clear communication channels.

Standard 2.2: Monitor communication for understanding

Assessment Considerations: When monitoring for misunderstandings, interpreters should consider:

• How could a misunderstanding affect the patient's care and safety?
• What is the emotional impact on the patient?
• Is this the best time to intervene?
• What action might help restore understanding?

Additional Prompts:

• Are there non-verbal signs of confusion I should address?
• Would a brief intervention help prevent a larger misunderstanding?
• How can I support understanding while maintaining my role boundaries?

Standard 2.3: Create space for clarification

Facilitation Approach: When possible, interpreters should help create conversational space for participants to work through misunderstandings directly, rather than resolving issues on the participants' behalf.

Decision Framework: Ask yourself: "Can the parties resolve this themselves if I simply continue interpreting, or do I need to intervene?"

Additional Examples:

• Notice signs of misunderstanding and choose the intervention that would best resolve it
• Allow natural conversational pauses for clarification
• Facilitate direct communication between parties

Standard 2.4: Manage flow of communication

Flow Management: Interpreters must balance the pace and flow to ensure accurate, complete information sharing while giving all participants equal opportunity to speak and be heard.

Standard 2.5: Conduct pre-session

Contextual Adaptation: Pre-sessions should be adapted to the situation. In emergency situations, interpreters may need to interpret immediately and postpone their pre-session until a calmer moment.

Standard 2.6: Participate in pre-encounter huddles

Preparation Questions: When participating in huddles with clinicians, interpreters should ask about encounter goals and specific communication needs of participants to better align with the encounter objectives.

Principle 3: Confidentiality

Standard 3.1: Share information only with healthcare team

Need-to-Know Basis: When asked to share patient information, interpreters must verify that the person requesting information is part of the patient's healthcare team and has a legitimate need to know.

Standard 3.2: Disclose information learned outside clinical setting

Patient Consent Framework: Interpreters should make every effort to encourage patients to share information themselves before considering disclosure without consent. Disclosure without permission is only appropriate when legally required or necessary to prevent serious harm.

Standard 3.3: Learn legal and institutional requirements

Legal Framework: Interpreters must research and understand legal requirements including Title VI of the Civil Rights Act of 1964, HIPAA, and ADA requirements in their jurisdiction.

Standard 3.4: Secure patient confidentiality

Workspace Security: Remote interpreters must create private home-office/workspace environments to ensure interpreted encounters are not overheard or observed by unauthorized individuals.

Standard 3.5: Ensure HIPAA-compliant note-taking

Documentation Security: All notes and records must be completely erasable at the end of encounters and disposed of according to HIPAA "safe harbor" guidance.

Standard 3.6: Omit identifying information

Professional Discussion Guidelines: When debriefing with colleagues or presenting at conferences, interpreters must remove all information that could identify patients, providers, or institutions.

Illustrative Example: During case discussions for professional development, interpreters discuss the ethical dimensions and communication challenges while completely anonymizing all parties involved.

Principle 4: Equitable Practice

Standard 4.1: Pay attention to communication needs

Adaptive Communication: Interpreters must adjust their techniques to support effective communication based on each participant's unique needs.

Additional Examples:

• Asking providers to show pictures of organs being discussed to enhance understanding
• Switching to the patient's preferred terminology when multiple options exist
• Adjusting volume of speech to ensure the patient can hear clearly
• Providing additional context or scaffolding when concepts don't translate directly

Standard 4.2: Respond to language preferences

Language Assessment: Interpreters should actively assess whether the assigned language is the patient's preferred and most comfortable language for healthcare communication.

Standard 4.3: Maintain objectivity despite personal beliefs

Professional Separation: Interpreters must consciously separate their personal beliefs and biases from the interpreted message, respecting the speaker's autonomy to express themselves and make their own decisions.

Standard 4.4: Disclose conflicts of interest

Withdrawal Protocol: When personal relationships or conflicts might compromise objectivity, interpreters should follow organizational guidelines for transferring assignments to other interpreters when possible.

Standard 4.5: Prioritize communication needs

Continuity of Care: When no other interpreter is available, interpreters must continue providing services while striving to remain objective and accurate, prioritizing the participants' communication needs over personal comfort.

Principle 5: Respect

Standard 5.1: Respect communicative autonomy

Natural Expression: Interpreters must allow individuals to express themselves at their own pace, respecting pauses, hesitations, and natural speaking rhythms to preserve authenticity and intent.

Complete Conveyance: Even when content is offensive or causes discomfort, interpreters convey the full meaning accurately and without omission.

Standard 5.2: Respect decision-making autonomy

Non-Manipulation: Interpreters avoid manipulating messages to convince participants to make choices the interpreter thinks are best, maintaining respectful demeanor even when disagreeing with decisions.

Additional Illustrative Examples:

• Supporting patient decisions even when interpreters personally disagree
• Avoiding judgmental tone or body language
• Maintaining professional neutrality in controversial situations

Standard 5.3: Promote direct communication

Facilitating Connection: The therapeutic relationship between patient and provider should remain central, with interpreters supporting but not becoming part of the conversation.

Additional Illustrative Examples:

• Positioning to encourage eye contact between primary speakers
• Using body language that directs attention to the main participants
• Avoiding becoming the focus of the interaction

Standard 5.4: Use culturally appropriate respect

Cultural Sensitivity: Interpreters must understand and use appropriate forms of address and greeting customs for all cultures represented in the encounter.

Standard 5.5: Share relevant missing information

Information Sharing Framework: When sharing information, interpreters should ensure it is relevant, objective, verifiable, and supports the encounter goals while maintaining appropriate confidentiality.

Principle 6: Cultural Competence

Standard 6.1: Alert to cultural misunderstandings

Cultural Bridge-Building: Interpreters help participants navigate cultural differences that may affect communication and understanding.

Standard 6.2: Provide cultural context

Contextual Information: Interpreters may provide relevant cultural or linguistic nuances to support informed consent, as long as it doesn't alter the speaker's message.

Standard 6.3: Assist with cultural expectations

Cross-Cultural Navigation: Interpreters help participants understand cultural expectations and behaviors that might not be shared, facilitating better interaction across differences.

Standard 6.4: Address untranslatable words

Comprehensive Examples:

• Patient uses culturally specific phrase to describe symptom; interpreter asks patient to explain meaning so it can be conveyed accurately to provider
• Doctor uses medical term with no equivalent in patient's language; interpreter asks for clarification
• Interpreters ask patients to explain words that have different meanings in different geographical areas within the same language

Additional Prompts:

• When I described/made a word picture of/used scaffolding to express a culturally specific term, did I let the speaker know how I expressed it?
• Does this term have meaning beyond the word itself that needs to be conveyed differently?
• Does this idea have cultural meaning that requires additional explanation?

Standard 6.5: Request clarification of untranslatable concepts

Collaborative Understanding: Interpreters create conversational space between speakers and listeners to arrive at shared understanding of concepts that don't translate directly.

Standard 6.6: Continue cultural development

Ongoing Learning: Interpreters must continuously develop understanding of how cultural practices and worldviews influence communication, meaning, and behavior.

Standard 6.7: Build cultural knowledge

Multi-Cultural Competence: Interpreters should develop understanding of cultures associated with their interpreted languages, including provider culture and biomedical culture.

Principle 7: Professionalism

Standard 7.1: Hold ourselves accountable

Professional Growth: Interpreters must demonstrate moral fortitude to behave ethically even when challenging, remaining open to feedback and actively taking steps to improve their practice.

Standard 7.2: Be honest and ethical

Credential Integrity: Interpreters must accurately represent their expertise and understand the difference between certificates of completion and professional certification.

Standard 7.3: Disclose barriers to interpreting ability

Transparency About Limitations: Interpreters must honestly assess and communicate when they need support to maintain accuracy, such as when experiencing fatigue.

Standard 7.4: Promote quality working conditions

Systemic Advocacy: Interpreters should tactfully and effectively advocate for working conditions that support quality professional interpreting.

Standard 7.5: Respect all professionals

Collaborative Environment: Interpreters should be considerate of healthcare providers, patients, and interpreter colleagues across all fields and modalities.

Standard 7.6: Act with professional dignity

Professional Boundaries: Interpreters maintain calm demeanor under pressure and avoid using professional relationships to establish personal social relationships outside the encounter.

Standard 7.7: Evaluate sight translation appropriateness

Document Assessment: Interpreters must carefully consider their skills, available time, and document appropriateness before accepting sight translation requests, protecting message integrity while building trust.

Standard 7.9: Be reliable and prepared

Professional Reliability: Interpreters test remote equipment in advance, arrive early for onsite appointments, and communicate promptly if delays occur.

Principle 8: Continuing Professional Development

Standard 8.1: Pursue continuing development

Respectful Terminology: Interpreters actively seek to understand and use respectful and appropriate terminology for all communities they serve.

Standard 8.2: Develop interpreting skills

Reflective Practice: Interpreters reflect on their work to polish their professional practice, transforming learning into effective action.

Standard 8.3: Participate in ongoing learning

Continuous Learning Examples:

• Familiarize themselves with respectful LGBTQ+ terminology in all interpreted languages
• Learn terms that describe languages (dialect, creole) and use them correctly
• Study different worldviews not representative of their own beliefs
• Continue learning about cultures associated with their interpreted languages

Standard 8.4: Seek feedback

Welcome Input: Interpreters thoughtfully consider new perspectives about their work, including input from bilingual patients or providers.

Standard 8.5: Support colleague development

Mentorship: Interpreters promote opportunities to participate in mentoring relationships with colleagues within their organization.

Standard 8.6: Participate in professional organizations

Professional Community: Interpreters regularly attend events and conferences to stay connected with their professional community.

Standard 8.7: Stay informed about technology

Technology Adaptation: Interpreters learn about AI technologies providers employ, including documentation tools, and assess how developments may influence their work.

Standard 8.8: Evaluate performance

Self-Assessment: Interpreters review challenging sessions and plan targeted growth activities based on critical reflection.

Standard 8.9: Develop collaboration skills

Interdisciplinary Competence: Interpreters participate in interdisciplinary training to deepen understanding of medical contexts and communication goals.

Additional Professional Development Resources:

• Independent study, classes, workshops, and continuing education
• Learning from interpreting experiences and other learning opportunities
• Seeking education on concepts and areas of study they haven't encountered
• Learning respectful terminology for diverse communities and identities

Principle 9: Advocacy

Standard 9.1: Assess objective and verifiable information

Decision Tree Framework:

1. Information Verification: Is the information that alerted me to potential risk objective and verifiable, not just my personal perspective or belief?
2. Confirmation Process: Can I confirm the information with the participants?
3. Transparency Approach: Can I address this through transparent question-asking rather than advocacy?

Example with Decision Tree: Interpreter wonders if taking two blood thinners might be problematic → Asks medical provider whether it's safe → Interprets the question to patient for transparency. This maintains transparency while addressing the concern without advocacy.

Additional Assessment Prompts:

• Is this information based on my professional training and practice-based knowledge?
• Am I making assumptions based on incomplete information?
• Have I separated my emotional response from the factual assessment?

Standard 9.2: Use interventions to avoid advocacy

Intervention Hierarchy (Decision Tree):

1. First Level: Ask participant who knows relevant information to share it with others
2. Second Level: Share information when none of the participants know it (if within interpreter scope)
3. Third Level: Create conversational space for clarification
4. Final Level: Direct advocacy only if imminent harm remains unaddressed

Examples of Non-Advocacy Interventions:

• Asking a participant who knows relevant information to share it with others
• Sharing institutional information that supports encounter goals
• Facilitating direct communication about potential issues
• Encouraging participants to address concerns directly

Immediacy Assessment (Decision Tree):

• Am I reasonably certain no one else will recognize and correct the potential harm before it occurs?
• Is the timeline such that normal communication processes won't prevent harm?
• Example: Clinician about to sedate patient for procedure → interpreter must speak while patient still awake

Advocacy and Patient Autonomy

Autonomy Respect Framework (Decision Tree):

1. Patient Understanding: Does the person at risk understand the risk?
2. Patient Preference: Do they prefer to speak for themselves, have interpreter advocate, or have no advocacy?
3. Respect Decision: Honor the patient's preference even if interpreter disagrees

Case Study - Rude Surgeon:

A surgeon was brusque to the point of rudeness. The interpreter conveyed the surgeon's tone and eventually asked the patient if the interpreter should say anything to the surgeon. The patient said, "No, it doesn't matter. I want excellent surgical skill from a surgeon; lack of social skill doesn't bother me." The interpreter respected the patient's autonomy and did not advocate.

Collaborative Advocacy Approach

Professional Advocacy Framework:

• Frame issues in terms of shared goals
• Respect each participant's sphere of expertise
• Use collaborative problem-solving approaches
• Maintain professional tone and approach
• Focus on patient safety and care quality

Systemic Advocacy Outside Encounters

Organizational Reporting:

• Follow organizational guidelines for reporting systemic issues
• Report patterns of disrespect toward patients
• Address barriers to healthcare access
• Advocate for appropriate language access policies

Examples of Systemic Advocacy:

• Tactfully persuading clinicians who speak some patient language to continue using interpreters
• Persuading supervisors to correct healthcare barriers
• Writing to legislators about language access policies
• Addressing patterns of implicit bias in healthcare settings

Mental Health Settings Note: Special considerations apply in mental health encounters, with additional safeguards and reporting mechanisms.

Principle 10: Health and Wellness

Standard 10.1: Recognize importance of self-care

Trauma Recognition: Healthcare interpreters are frequently exposed to secondary traumatic stress, vicarious trauma, compassion fatigue, ethical stress, burnout, acute stress reactions, and cumulative stress.

Self-Care Activities:

• Debriefing sessions and reflective practice
• Case conferences and peer support meetings
• Counseling and professional support
• Reframing techniques and resilience building
• Physical health maintenance (diet, sleep, exercise)
• Use of personal protective equipment when onsite

Standard 10.2: Collaborate on wellness programs

Workplace Wellness:

• Proactively suggest activities that support wellbeing
• Learn about countertransference and recognize when it affects performance
• Seek appropriate coverage when unable to continue interpreting effectively
• Ask for periodic case conferences and support

Standard 10.3: Develop coping strategies

Trigger Management: Interpreters must recognize situations that might trigger strong emotional responses based on lived experiences and develop strategies to manage emotions while maintaining focus.

Emotional Distance Techniques: Learn to create emotional distance while remaining kind and caring, conveying participants' emotions without vicariously experiencing them.

Principle 11: Scope of Practice

Standard 11.1: Reflect on ethical principles

Ethical Decision-Making: Interpreters must be aware of the continuum of ethical possibilities and choose options that best serve participants' goals and well-being in each situation.

Standard 11.2: Respect expertise and autonomy

Professional Boundaries:

• Redirect advice requests to appropriate experts
• Refrain from providing medical advice, even with medical training
• Avoid activities clearly beyond professional scope
• Interpret to facilitate direct expert consultation when possible

Standard 11.3: Practice professional discretion

Decision Evaluation: Interpreters must evaluate whether their actions align with professional responsibilities and uphold ethical standards, prioritizing values and principles most important in each encounter.

Standard 11.4: Clarify role expectations

Role Clarity Examples:

• Interpreters hired for multiple roles make clear which they're performing at any time
• Interpreter-nurses clarify when doing nursing teaching vs. interpreting
• When asked to assist with non-interpreting tasks (wheelchair, IV pole), explain scope limitations

Standard 11.5: Maintain professional distance

Professional Kindness: Balance kindness with professional distance, keeping personal healthcare experiences private while remaining caring and professionally appropriate.