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Language Access


Effective communication is critical for diagnosis, treatment, and delivery of services. Research shows the direct connection between quality of care, positive outcomes, customer satisfaction, and the provision of effective language services for individuals with communication or language needs.

LANGUAGE ACCESS PLANNING - Language access is also required by federal law for all organizations that receive federal funding. Those who do not comply with the law can be at risk of investigation, losing their license, and civil and criminal lawsuits. Providers can enhance outcomes and reduce their liability risk by using Language Assistance Plans.  Find toolkits, templates, checklists, and other materials related to language access planning here.

QUALIFIED BILINGUAL STAFF PROGRAM - QBS are a critical link to providing effective communication and quality care to the limited-English proficient (LEP) communities and individuals we serve.  

HEALTH LITERACY - Health literacy is an often forgotten but important aspect of language access.  Make sure your organization considers literacy in all aspects of communication planning.

LOOKING FOR TRANSLATED DOCUMENTS? Check here and check back often.  Our list is growing.

ANNUAL LANGUAGE ACCESS LEADERSHIP CONFERENCE - An annual conference designed to explore the implementation, funding, sustaining, and evaluation of language services in government services. Always a FREE event.

Practice-Based Guidance for Working with Interpreters in Clinical Settings

  • Use trained interpreters, not bilingual staff or community members -Untrained interpreters allow for inaccurate or summarized communication, they can try to normalize comments or behaviors and are less likely to keep sessions confidential.
  • Allow the interpreter to explain their protocols to you and the individual- Interpreters are trained to use different methods based on the circumstances. The interpreter should explain these protocols to ensure clear communication.
  • Stress stigma associated with mental health that can influence interpreters- Professional and untrained interpreters may not understand the complexity of mental health and can bring their own bias to a session. For interventions to be effective, this needs to be addressed.
  • Define roles clearly- Roles must be understood and respected. The interpreter should not offer counseling and the provider should not interpret the individuals’ words.
  • The provider should discuss the goals for the session with the interpreter before seeing the client- Providers often have specific goals for each counseling session. The interpreter needs to be aware of these goals to work with the provider towards reaching common outcomes.
  • Include a little time to meet with the interpreter before and after each session to discuss concerns or answer questions- The provider and the interpreter will not always understand the other’s methods. Allow time to communicate about a session to reduce problems or confusion and be sure this isn't done in front of the individual you are serving.
  • Recognize that even though someone may be bilingual they must still be trained with the skills that make them good interpreters -Just like providers are trained in a profession, bilingualism doesn't mean someone is automatically an interpreter.  Check to see if they have been trained in cultural competence and cross cultural communication and help them understand the importance of culturally and linguistically sensitive interventions.
  • Build a team - Providers and interpreters are both essential to good care. Emphasizing mutual respect facilitates better outcomes.
  • Use tools to assess communication - Even though you may not speak the language, you can use a tool to gauge whether a particular interpreter is delivering the message with some accuracy.  One such tool can be found here.

Adapted from the Center for Health and Health Care in Schools, School of Public Health and Health Services, the George Washington University



The Commonwealth has contracts with several vendors in various state agencies.  As a local agency or local government, you may be able to sign on to the same contract and benefit from the lower cost. If you would like more information, contact OCLC.



How working with interpreters supports HIPAA

Interpreter Waiver Template 

CLAS InterpetTool

Working with an Interpreter 

Key Points to Consider when Translating Documents

When developing plans and guidance regarding translation of documents, how do we determine which documents must be translated?

It is important to ensure that written materials routinely provided in English also are provided in regularly encountered languages other than English.

It is particularly important to ensure that vital documents are translated into the non-English language of each regularly encountered LEP group eligible to be served or likely to be affected by the program or activity.

A document will be considered vital if it contains information that is critical for obtaining state or local services and/or benefits, or is required by law. Vital documents include, for example: applications, consent and complaint forms; notices of rights and disciplinary action; notices advising LEP persons of the availability of free language assistance; facility rule books ; written tests that do not assess English language competency, but rather competency for a particular license, job, or skill for which English competency is not required; and letters or notices that require a response from the beneficiary or client. For instance, if a complaint form is necessary in order to file a claim with an agency, that complaint form would be vital. Non-vital information includes documents that are not critical to access such benefits and services.

I speakVital documents must be translated when a significant number or percentage of the population eligible to be served, or likely to be directly affected by the program/activity, needs services or information in a language other than English to communicate effectively.

For many larger documents, translation of vital information contained within the document will suffice and the documents need not be translated in their entirety. If the document is something that the individual would take home with them to refer to later, it is not acceptable to have it read to them by an interpreter and then given to take home.

If it is legally binding, it must be in the language in which they read. If it is a document they are required to sign, it must be in a language in which they are able to read.

It may sometimes be difficult to draw a distinction between vital and non-vital documents, particularly when considering outreach or other documents designed to raise awareness of rights or services.

Though meaningful access to a program requires an awareness of the program's existence, it would be impossible, from a practical and cost-based perspective, to translate every piece of outreach material into every language. Title VI does not require this of of state and local agencies. Nevertheless, because in some circumstances lack of awareness of the existence of a particular program may effectively deny LEP individuals meaningful access, it is important for your organization to continually survey/assess the needs of eligible service populations in order to determine whether certain critical outreach materials should be translated into other languages.


    Questions to ask when identifying documents for translation

    What languages are most common in our agency? In our area?  An assessment of language spoken in your agency as well as the languages spoke in your catchment area is critical to knowing what should be prioritized for translation. Who can do this? Vendors? Universities?  Do not use bilingual staff unless they are trained as translators.  This is requires a specific skill set and not everyone who is bilingual is competent to translate.

    Costs? Some vendors are more affordable than others, but beware; sometimes you get what you pay for.

    Who can review this? It is standard to have people in your community to review the translation.  Just as there are regional and country variations in English, there are variations in other languages.  These variations can impede the understanding of the person reading the document.  Community reviews also help to set the reading level of the document.  You don't want to translate a document at a level that is too high or too low for the reader. 

    Who can coordinate? It is useful to have one person coordinate the translations in an organization.  This way, they begin to know the vendors who are reputable and prompt.  They are able to keep the different versions in order.  And they are able to share translated versions among various divisions which can save on duplication of translation services.

    translation process

    What about forms? Forms are a complex translation problem because there are often portions to be completed by English speakers who don't read or write in another language.  Policies and procedures must be in place, and staff must be trained to ensure that translated forms are used correctly.  A translated form that is completed in English may be of no use to an individual who is limited English proficient.  It is certainly not the intended use of the form and wasted time and money.

      Questions to ask vendors to ensure quality translations

      • Does the provider use translation memory tools? This is the industry standard. All professional providers should offer this as a feature to you. This results in cost savings due to economies of scale & translation terminology memory that is leveraged over time.  Are there any hidden costs? Do not judge only on price per word. Ask for a clear list of all charges; if certain services are not offered (editing, proofreading, desktop publishing), where will these services be obtained?
      • Does the provider offer culturally appropriate services? Ensure that your provider does cultural adaptation - not just simple linguistic transfer.
      • Can the provider assist with literacy issues? If you know the average reading level of your target population, the translation provider should be able to adapt the reading level.
      • Am I protected? The organization should provide qualified and certified translators only, and should offer comprehensive insurance.


      Language Selection in Individuals who are Bilingual

      Language, Culture, and Emotion

      In an article entitled, Bilingualism: Language, memory, and applied issues, Jeanette Altarriba, Ph.D describes how language, culture, and emotion are connected.  She notes that emotions are often shaped by the social or cultural context in which they are experienced and they are are most commonly expressed using language and language labels in therapeutic sessions, emotion and culture can be examined through the use of the language in which they are expressed.

      There is a growing body of research that describes how an individual who is bilingual may consciously or subconsciously select the language they use in a given moment.  Likewise, studies have shown that words themselves elicit different emotions when spoken in one's native language as compared to the second language. It is now understood that language may be used to shelter individuals from trauma or memories, also known as state-dependent (Shrauf, 2000).  There may be a set of taboo words associated with greater anxiety when presented in the native language instead of the second language (Gonzalez-Reigosa, 1976).  

      There is a well accepted theory that the second language can serve as an intellectual function and help to create emotional detachment; whereas the native language clearly expressed the emotional content (Marcos, 1976).  Additionally, there is a simple proficiency explanation for language selection.  Even individuals with relatively high levels of proficiency may find that it is difficult to find the emotional vocabulary in the second language to express themselves in greater emotional detail (Altarriba, 2000). 

      Whereas the native or more dominant language might encode issues regarding culture, socialization practices, or childhood memories, the second language might function as a tool for tapping non-emotional topics or memories from adulthood. Understanding the nuances of language selection for individuals who are bilingual is incredibly important for clinicians. Especially when doing assessments.

      It is not enough to ask them whether they speak English. Clinicians must not only use their clinical skills to assess the entire situation but also check any bias they might be feeling about the language switching to evaluate whether language, proficiency, and language selection are impacting the communication and information you are receiving.


      Altarriba, J. (2002). Bilingualism: Language, memory, and applied issues. In W. J. Lonner, D. L. Dinnel, S. A. Hayes, & D. N. Sattler (Eds.), Online Readings in Psychology and Culture (Unit 4, Chapter 4), Center for Cross-Cultural Research, Western Washington University, Bellingham, Washington USA