Working with Interpreters
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The document provides guidance for healthcare providers on effectively utilizing interpreters to enhance communication with patients who have limited English proficiency. It outlines the essential roles of interpreters, their necessary qualifications, and best practices for structuring interpreted encounters. Key points include the legal requirements for providing language access, the differences between interpreting and bilingualism, and strategies to ensure clear communication and improved health outcomes.
Working with Interpreters
- 1. WORKING WITH INTERPRETERS FOR HEALTHCARE PROVIDERS 2018 Presented by Eliana Lobo of Lobo Language Access
- 2. TODAY’S GOAL: LEARN HOW TO MAKE YOUR INTERPRETED COMMUNICATIONS MORE EFFECTIVE AND EFFICIENT
- 3. AT THE CONCLUSION OF THIS PROGRAM YOU WILL BE ABLE TO: • Identify the multiple roles of an interpreter • Structure an interpreted encounter • Identify best practices • Identify behaviors to avoid in interpreted encounters • Know where to seek cultural consultation
- 4. WHO SHOULD INTERPRET? An interpreter, NOT a family member An interpreter, NOT a co-worker Medical interpreters should be trained and certified National certification insures quality interpretation WA state requires interpreters to take the DSHS medical interpreter exam, which tests language proficiency, ethical knowledge and standards of practice If you receive Federal funds, you are mandated by Title VI to provide meaningful language access If you receive Federal funds, and you practice in WA, you may only use the services of DSHS certified or authorized interpreters
- 5. BEING BILINGUAL DOES NOT GUARANTEE INTERPRETING SKILL! “Generic bilingualism” is not enough because interpreting is not a generic activity. Interpreters work in specific contexts and use specific vocabularies whose meanings and usage change from context to context, both between subject areas (medical, legal, etc.) and within subject areas (folk medicine, advanced cancer treatment, etc.).” http://www.atanet.org/chronicle/3707_22_johnson.pdf
- 6. IT GOES BEYOND HAVING TERMINOLOGY EQUIVALENTS! “Even the acquisition of vocabulary and cultural understanding is not enough because bilingualism alone does not address communication between languages. Bilingualism is usually defined in terms of communication in two languages, not as the ability to communicate between two languages.” http://www.atanet.org/chronicle/3707_22_johnson.pdf
- 7. THE EIGHT STEPS OF SPEECH PRODUCTION (IN A SINGLE LANGUAGE) For someone speaking a single language, it looks like this: 1. Speech sounds and other stimuli are received by your ear or hearing aid 2. These sounds are converted to bioelectric signals within the human ear, or within the hearing aid device. 3. These electric impulses are then transported through specific ganglial structures, ending up in the primary auditory cortex, on both hemispheres of the brain. Interestingly, each hemisphere treats this input differently 4. The left side recognizes distinctive parts such as phonemes or basic sounds of speech, whereas the right side takes over melodic/prosodic characteristics 5. The input then moves through the following areas in the brain that process 6. speech perception 7. semantic association, and only then does it move to 8. speech production Only EIGHT steps! prosodic features in the English Language include stress, pitch, intonation, pauses, loudness and pace, paralinguistic features and vocal effects
- 8. 11 STEPS TO SPEECH PRODUCTION (IN TWO LANGUAGES) • When we move from communicating in a single language to interpreting, we add the following tasks to the mix: • Memory • Conversion • Iteration • The interpreter’s brain is now handling ALL of the prior tasks, plus three new tasks. Essentially adding 3 balls to the 8 balls already being juggled!
- 9. BEING BILINGUAL DOES NOT GUARANTEE INTERPRETING SKILL! “The ability to take another person’s ideas, which are expressed in that person’s own idiolect, and transfer those ideas to another language while faithfully communicating the message in all its aspects is the crucial element that separates translation and interpreting skills from mere bilingual skills.” http://www.atanet.org/chronicle/3707_22_johnson.pdf
- 10. WHY INTERPRETERS? Clear communication is an essential tool for diagnosis, treatment and compliance • Safety issues • Liability issues • The law requires it: Title VI of the 1964 Civil Rights Act The Americans with Disabilities Act 1990 DSHS Guidance of August 2000 • CLAS Standards • Joint Commission standards beginning in 2004
- 11. WHY INTERPRETERS? AHIT-Texas Association of Healthcare Interpreters and Translators-PSA
- 12. BEFORE WE DIVE IN, • Do you know how to schedule an interpreter in advance of the appointment date? EPIC uses Cadence for this, what does your hospital use? • Do you know how to reach a telephonic interpreter? • If your hospital or medical center contracts with a video vendor, do you know where the cart is and how to use it? Malpractice insurance will NOT cover you for mistakes in this area, (provision of language access). Failing to offer an interpreter to a patient who needs one is legally considered to be a CIVIL RIGHTS VIOLATION, and malpractice insurance does not cover that!
- 13. DOCUMENTING INTERPRETER NEED • EPIC users Registration: during registration (in the demographics section), and prior to the scheduling of any appointments, the Patient Services Specialist enters the preferred language & indicates "Yes" in the in needs interpreter field there are some documentation comments required Out-patient appointments: This presentation assumes that you, or your facility, knows how to do the above. Today, we will focus on how to best partner with an interpreter for good clear communication, and improved health outcomes.
- 14. WHAT DO INTERPRETERS DO? • Transmit meaning from one language to another
- 15. MODES OF INTERPRETATION • Consecutive Interpreting after the speaker or signer has completed one or more ideas in the source language and paused, allowing the interpreter to transmit the information Most often used in community and health interpreting • Simultaneous Interpreting into the target language at nearly the same time as the source language is being delivered Most often used in court interpreting • Sight Translation Oral translation of written text
- 16. WHAT ARE THE ROLES OF AN INTERPRETER? • Conduit transmitting everything • Clarifier changing the form of the message, in order to preserve the intent and meaning of the message
- 17. INTERPRETER ROLES • Cultural broker providing the necessary framework for understanding the message being transmitted • Advocate taking action on behalf of either the patient or the provider outside the bounds of the interpreted encounter
- 18. STRUCTURING THE INTERPRETED ENCOUNTER • Pre-session Check that interpreter is wearing a badge with photo Verify patient’s language preference Record the name of the language Record the name of the interpreter • Introductions • Encounter • Post-conference
- 19. INTERPRETER BADGES National certification Agency sub-contractor
- 20. ALWAYS ASK YOUR INTERPRETER ABOUT THEIR CERTIFICATION STATUS • Who certifies healthcare interpreters nationally? • RID, (Registry of Interpreters for the Deaf) certifies ASL interpreters, however, RID does not offer a healthcare specialization • CCHI, (Certification Commission for Healthcare Interpreters) an accredited body, certifies spoken language healthcare interpreters in all languages as well as ASL interpreters • NBCMI, (National Board of Certification for Medical Interpreters) a non-accredited body, certifies spoken language medical interpreters in Spanish, Russian, Mandarin, Cantonese, Korean, and Vietnamese Not using certified interpreters has long-term negative consequences for patient safety, quality of care, hospital liability, health outcomes, as well as compliance with Federal laws and regulations.
- 21. THE PRE-SESSION • Introduction What are the time constraints? Names How would you prefer to be addressed? Establish the context, nature and goal of visit Is there cultural information that would be helpful in this encounter? • Encourage the interpreter to ask for clarification if something you say isn’t clear • It isn’t just the interpreter who may pronounce English with a regional or national accent!
- 22. POSITIONING DURING THE ENCOUNTER • Be aware of positioning and audio clarity Room sizes and configurations vary, but try to position yourself where the patient and interpreter can both see and hear you as well as each other, for all clinical appointments For in-patients in recovery or critical care, have the interpreter stand on the same side of the bed as you, to avoid creating a tennis match viewpoint for the patient For remote situations (telephone or video) make sure everyone can hear what is being said. Often, video remote interpreters can raise or lower volumes at both ends, but phone interpreters can only control their end. Sometimes you need to make adjustments on your own phone set-up • Look at the patient while they are speaking! Match the interpreted content to what you just observed
- 23. NOTE INTERPRETER NAME IN THE EMR • Confirm language preference with patient, then compare with language indicated in EMR • Ask the patient if they understand the interpreter • If you are not a native speaker of English, ask they interpreter if they understand you • Note the language and any other relevant details (specific dialect for example) in the EMR
- 24. THE THREE MAJOR ELECTRONIC MEDICAL RECORD APPLICATIONS • EPIC • In-Patient: Language preference should appear in PRELUDE, the registrations module within EPIC • Out-Patient: Language preference should appear in CADENCE, the scheduling module within EPIC • Note language details (such as dialect) that become apparent during the encounter, on the patient education/hands-on teaching page • CERNER • SORIAN
- 25. THE ENCOUNTER ONCE YOU HAVE ESTABLISHED GOOD POSITIONING • Remember to LOOK at the patient while they are speaking • Match interpreted content to what you just watched • Establish that anything that anyone says will be interpreted and kept confidential then, and only then do you • Speak to the patient, not the interpreter • Speak in first person • Speak in relatively short segments • Pause frequently
- 26. HARBORVIEW MEDICAL CENTER ENCOUNTER FEATURING REMOTE VIDEO INTERPRETATION
- 27. CONSENTS & HIPAA • Take the time to explain about privacy laws and HIPAA prior to beginning the consent process • HIPAA does not exist outside the U.S. • Explain that all manner of risk, side effects and potential outcomes are standard when explaining a procedure or surgery to patients so they can be fully informed • Otherwise, you risk frightening the patient into postponing treatment
- 28. POST-CONFERENCE • Is there additional cultural information that will help me to care for this patient? • Is there anything I could have done differently to facilitate your interpretation? • After a difficult or traumatic session, “How are you doing?” Standard questions to ask the interpreter:
- 29. DO’S AND DON’T’S • You’ve set the stage by • Confirming language preference • Positioning yourself correctly • Introducing yourself • What are some other things you can do to control or enhance clearer communication?
- 30. AVOID • Idiomatic speech or slang • E.g., “you’re out of the woods”, “feeling blue”. Better to be boring and direct in your speech • Using ACRONYMS • Interrupts the interpreter’s internal flow and can really slow down communication • Complicated sentence structure, particularly when ideas change mid-sentence • Collect and order your thoughts first, then speak clearly, pausing often • Asking more than one question at a time • GENDER MIS-MATCH (between provider and patient) • A match facilitates obtaining intimate personal information or choice
- 31. WHEN YOU WORK WITH A QUALIFIED AND CERTIFIED INTERPRETER YOU HELP • Reduce overutilization of the Emergency Dept. as the locus for primary care • You reduce the number of medication errors that occur • You improve LEP patients’ adherence to their care plans • You shorten LOS for LEP patients • You reduce readmission rates for LEP • You help reduce health disparities!
- 32. REMEMBER • Concepts, diagnoses and treatments that can be expressed briefly in English, may have no linguistic equivalent in the target language. • This often leads to the use of: Descriptions Word pictures Much lengthier exchanges
- 33. CULTURALLY COMPETENT RESOURCES FOR YOU TO LEARN MORE ABOUT YOUR REFUGEE & IMMIGRANT PATIENT POPULATION • WWW.ETHNOMED.ORG • WWW.DIGITALLITERACY.GOV/HEALTHY-ROADS-MEDIA • WWW.STORE.HEALTHYROADSMEDIA.ORG • WWW.HABLAMOSJUNTOS.ORG • WWW.HHS.GOV/CIVIL-RIGHTS/FOR- INDIVIDUALS/SPECIAL-TOPICS/LIMITED-ENGLISH- PROFICIENCY/INDEX.HTML
- 34. QUESTIONS? Contact: Eliana Lobo Director InterpreterTrainer@outlook.com Lobo Language Access