Voces Language Services Program

Michigan Nightlight: In your view, what makes your program innovative, effective or remarkable? 
Voces Executive Director Kate Flores: The Language Services Program uses a comprehensive approach—not only do we provide direct interpreting services, we also work to build and strengthen the community’s system for language access for limited English proficient families. Our ultimate goal is that limited English proficient families in our community will have full and equal access to health care, education, and other essential programs and services that support their well-being. This means that the institutions in our community need to have a strong and healthy system for language access, one of which is high quality and free for families (in compliance with federal law).  
 
Right now this system is broken. What often happens is that when a patient needs to go to a doctor’s office, they are told that they need to bring their own interpreter, that it is their responsibility. The provider relies on the patient’s family member or a child or someone else who is not an appropriate or qualified person to be interpreting. One of the goals of the Language Services Program is to take children out of the interpreter role because it puts unnecessary pressure on children.

One of the goals of the Language Services Program is to take children out of the interpreter role because it puts unnecessary pressure on children.

It also impacts family power dynamics when parents rely on their children. At times, children are even asked to miss school to perform this function. This is a situation we want to prevent. In most cases it is the provider’s responsibility, if they get any federal funding (including Medicaid or Medicare), to provide interpreter services and ensure meaningful language access.  Therefore, a key part of our program is partnering with providers to educate them about their responsibilities and help them build their capacity to appropriately serve these families.
 
For example, we are currently about to begin a pilot program in the birth center of our local hospital in which we not only will be providing in-person interpreting services, but we will be working with them to train their staff, develop appropriate policies, test and create guidelines for use of various interpreting modes – for example, in-person interpreters, phone interpreters, visual tools – and create a tool kit of posters, flip charts, and other resources to improve communication. Overall, our program’s focus is not just about providing a service or generating revenue, but about building and increasing access, inclusiveness, and cultural responsiveness within our community.
 
Our focus so far has been on the Latino/Hispanic community. However, this is an issue shared by all immigrant communities with members who speak limited English, or at least insufficient English to fully communicate in a medical setting. Some individuals speak excellent English yet prefer to receive medical care in their primary language.  Local hospital data shows over 50 other language groups in our area; we are building our program to partner with and include services for these other communities. 
 
What was the best lesson learned in the past year?
In the last year, we have worked on restructuring our service. Prior to restructuring, we had just one full time staff person who did all of the coordinating and the interpreting.  We transitioned into our current staff structure, and now we have one coordinator and various interpreters. Through that process, we hired a national consultant who focuses on language services. She helped us with creating and revising our policies and setting up this new system. We learned the value of bringing in outside help when we need it. 
 
When we started this program, there was a need, which we were able to address immediately. There was a lot of learning that happened in the process, and part of that was realizing that we do not need to reinvent the wheel. There are national models and best practices that already exist. We need to learn and align ourselves with that to create the high quality program and service that we envision. That was an important lesson and process that we went through in the last year.
 
What was the hardest lesson learned in the past year?                            
We still have a very long road to go with providers. Though we have known this and understand that changing systems takes time, we had some experiences this year that have shown us how very long that road still actually is. There are major needs for education around providers’ legal responsibilities, cultural competency and skills for working with diverse populations, and understanding of an interpreter’s role and how to effectively work with one. Many providers continue to assume it is the patient/client responsibility to provide an interpreter and assume that any bilingual person can interpret. There are also providers who fully know their legal responsibilities yet still refuse to pay for or provide the quality of services required or necessary. Discrimination and lack of understanding of the immigrant experience is often also an element.
 
What really differentiates this program?
As discussed, our focus on systems building is one of the main areas that differentiates this program. Most language services programs just provide services with a straight fee-for-service model based on contracts with hospitals and health providers. Our program works to build and increase full and equal access to services as its central focus. Though this does also mean services through fee-for-service contracts, we are able to engage in deeper and more creative partnerships. For example, we are currently working on developing our program model to include a resource tool kit and training for providers on how to work effectively with interpreters. We have also been able to customize our work at the hospital based on their needs and are partnering to help them come up with the best system that works in their specific context. 
 
In the meantime, as we build these partnerships and strengthen the system, we have also had the flexibility to work directly with patients and families. They can also call us directly to request services. Though we hope to reduce this part of the service as providers take greater responsibility for providing services, this flexibility has been important so far to ensure that immediate needs for access to health care are being met.  We are also able to provide additional support services to families.  In addition to interpreting services, we help connect them with other community resources, apply for health insurance, get help with medical bills, get help with medical transportation if needed, or address other needs they may have.
 
What are the keys to success for your program?
One thing we realized early on was that we do not have a sufficient pool of trained interpreters in our community. In the past, if a person was bilingual that meant they could interpret. Interpretation is not just about being bilingual. There is a skill set, an ethic, to interpret. Interpretation in general, and medical interpretation specifically, is a growing and developing field. In the last several years, a process has developed nationally around certification and training. We partnered with Kellogg Community College to develop an interpreter training program last year, and we placed the interns in a number of different settings. This has been one of our successes. We looked at the system in the community and became very diligent about building the interpreter profession. In general, developing our internal capacity and the human resources needed to do this work has been very important to us. We are very proud of the high quality of our service and our interpreters, and our alignment with best practices. 
 
Related to the capacity building of other organizations, one of the roles and strategies we have taken is to be a connector between residents and those agencies. In order for organizations to change and improve their services to limited English proficient families, it is necessary and most effective for them to connect with them and begin building a relationship directly.

In order for organizations to change and improve their services to limited English proficient families, it is necessary and most effective for them to connect with them and begin building a relationship directly.

The impact is much greater when they can meet and listen directly to a family or individual about their experiences and lives, rather than just what we, staff members at Voces, are able to tell them. To this end, we have organized a number of such conversations related to topics such as mental health, hospital services, diabetes, early childhood, and education. This process has both impacted the various organizations involved and provided a space for community members to have a voice and be listened to; it’s meaningful on both ends. Overall, being this connector and providing a space for relationship building has been one of the keys to our success. 
 
Finally, diligence, patience, and persistence…it is a long road, but poco a poco (little by little) we are making a difference.
 
In looking at programs similar to yours, which program do you think is doing exceptional work?
In Michigan, the Hispanic Center of Western Michigan, Voices for Health, and the University of Michigan have strong language services programs. Much other great work is happening on the east and west coasts.