Translation and Interpretation Recommendations

The 2016 Language Needs Assessment Report makes recommendations to local health districts (LHD) around which languages should be provided on-site interpretation services or translated materials. Resources to assist in providing these services are available throughout this CLAS website. The recommendations reflect the following minimum LEP requirements:

500 LEP patient encounters in a language for on-site interpretation in that language; when a district experiences 500 local LEP encounters specific to one language, an on-site interpreter is recommended for that specific language at the district.
5% of all patient encounters or 1000 LEP patient encounters in a language for translation of vital documents in that language. The translation of primary documents for any foreign language is recommended when a district experiences 5% of all patient encounter or 1000 LEP patient encounters of a specific language, whichever is less.
This requirement is established by the Department of Health and Human Services, and documented in the “Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons, 2003.”

The dashboard below shows the languages for which an on-site interpreter and/or translated materials are recommended by local health district (LHD). Use the map to select individual LHDs or hold down the [ctrl] key to select multiple districts. Counties and independent cities on the map are shaded by the proportion of residents that speak English less than well. Hovering reveals further details about each locality.

The dashboard also includes estimates for the cost of an interpreter based on the hourly median wage of $30.00 for Interpreters and Translators (SOC 27-3091) in Virginia according the the US Bureau of Labor Statistics. Cost estimates are calculated using the number of visits in 2014, with each visit expected to take one hour. Estimates are also included for an annual increase in pay of $500-$1,500 for bilingual employees, who are estimated to handle 500 LEP encounters in the target language.

Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons

There is no “one size fits all” solution for Title VI compliance with respect to LEP persons, and what constitutes “reasonable steps” for large providers may not be reasonable where small providers are concerned. However, the Guidance states specifically that recipients cannot require LEP persons to bring their own interpreters or use family members or friends as interpreters.

Identifies the following as “safe harbors” for compliance with meaningful access to translated written documents. The following actions will be considered as “strong evidence” that an agency/organization has complied with its written translation requirements:
Written translations of vital documents are provided for each eligible LEP language group that constitutes 5% or 1,000, whichever is less, of the population of persons eligible to be served or likely to be affected or encountered. Oral translation of other non-vital documents is permitted.
If there are fewer than 50 persons in a language group that reaches the 5% trigger, the practice may, as an alternative to translating vital written materials, provide written notice in the primary language of the LEP language group of the right to receive competent oral interpretation of the written materials without cost.

Notification of Rights: Both verbal offers and written notices informing clients of their right to receive language assistance services at no cost to them. For this purpose, VDH has designed a language identification poster that informs patients in 32 languages of their rights to a trained interpreter at no cost. Copies of this poster should be displayed at all offices of the health district and as appropriate in multiple locations within offices. The poster is available online at https://apps.vdh.virginia.gov/omhhe/clas/.

Interpretation Services: Interpretation services should be provided to all LEP patients at no cost and at all points of contact in a timely manner during all hours of operation. LEP persons cannot be required to bring their own interpreters nor should they use family members or friends as interpreters unless specifically requested by the patient/consumer after receiving notification of their rights to receive language assistance services at no cost to them. On-site interpretation should be provided in any language whose speakers are at least 500 of the district’s patient encounters.

Assurance of Competence: have a mechanism for assuring the competence of the language assistance provided. It is recommended that each LHD utilize interpreters and translators (whether they are in-house, bilingual professional staff, or contract interpreters and translators) who:

have been screened and tested for proficiency in both English and the target language(s),
have received a minimum of 40 hours of training as professional medical/health care interpreters (the training should include, but not be limited to, the following topic areas: ethics and confidentiality, medical terminology, basic anatomy and physiology, roles, and cultural competence),
adhere to an interpreter and translator Code of Ethics, a statement of confidentiality, and are aware of and comply with HIPAA related privacy guidelines,
participate in ongoing medical/healthcare interpreter and translator continuing education,
have subject matter expertise in medical and health care and prior experience translating medical/health documents,
are able to write at an appropriate reading level for the target audience,
have been screened and tested for proficiency in both written English and the target language(s) with affiliation/accreditation by the American Translators Association preferred,
are able to act as a cultural bridge, providing VDH with feedback not only on grammatical and linguistic accuracy, but also on cultural appropriateness,
do not rely on software-based translation programs, and,
are covered by liability insurance.

Translated Materials: make available easily understood patient-related materials and post signage in the languages of the commonly encountered group and/or groups, including written translations of vital documents for each eligible LEP language group recommended for translation materials.

The 2016 Language Needs Assessment Report defines “Vital Documents” as follows:

Consent and complaint forms
Notices advising LEP persons of free language assistance
Intake forms with potential for important health consequences, ex.: Consent to Treat Form
Written tests that do not assess English language competency, but test competency for a particular license, job or skill for which knowing English is not required
Written notices of eligibility criteria, rights, denial, loss, or decreases in benefits or services
Applications to participate in a recipient’s program or activity or to receive recipient benefits or services
Actions affecting parental custody or child support, and other hearings