USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW

1. Technical Assistance Partnership Cultural and Linguistic Competence Community of Practice USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA

2. Outline • Need for interpreters in systems of care • Federal regulations • Current workforce issues • Consequences for not using properly trained interpreters • Roles/models of interpreting • What an interpreter is not • Helpful hints • Systems issues

3. Serious Disparities of Quality Care for Communities of Color: The lack of representation of service providers in mental health from the Latino, African American, Asian American/Pacific Islander and Native American communities has resulted in serious disparities of quality care for all communities of color These disparities are particularly critical for those with limited English proficiency who remain isolated not only by cultural barriers but also language barriers that prevent them from receiving proper care

4. Mental Health Interpreter Training Goals To produce culturally competent interpreters who are able to identify the language and cultural interpretation needs of the monolingual and limited English proficiency clients To help interpreters gain the knowledge and skills to perform effectively in the interpreting roles that best serve the clients and the providers in mental health settings

5. Need for Training Interpreters • There continues to be a serious lack of trained bi-lingual, bi-cultural service providers • Only 6% of psychologists, 8% of counselors and 11% of social workers are from communities of color US Dept. of Health and Human Services, Center for Mental Health Services (2001) • Having a Ph.D. or MD does not guarantee that a person will be culturally competent • Being bi-lingual does not in and of itself qualify a person to be clinically qualified

6. Interpreter as Part of Professional Team Linguistically proficient trained Interpreter Culturally competent Provider + = Quality services for consumers and family

7. Federal Regulations • Title VI – Civil Rights Act of 1964 • Executive Order 13166 (August 2000) • The President’s New Freedom Commission on Mental Health • Office of Civil Rights Regulations • Culturally and Linguistically Appropriate Services (CLAS) • The National Council on Interpreting in Health Care (NCIHC) - First National Standards for Medical Interpreters - 32 Standards – November, 2005

8. The National Council on Interpreting in Health Care (NCIHC) November, 2005 First National Standards for Medical Interpreters 32 Standards http://www.ncihc.org

9. California State Department of Mental Health Threshold Languages Definition of Threshold Language: 3,000 Medi-Cal Beneficiaries or 5% of Medi-Cal population whose primary language is other than English, whichever is lower • List the threshold languages in your county • What are the threshold languages in your community? • How well are these needs being met?

10. The Value of Properly Trained Interpreters • Improves communication between client and service provider • Improves capacity to gather accurate background information • Allows for appropriate assessment, diagnosis, testing and screening • Can function as a cultural broker • Results in better understanding of treatment plan and reduces unnecessary hospitalization

11. The Value of Properly Trained Interpreters (cont’d) • Expands a client’s choices in accessing clinicians – assuming the clinician is culturally competent • Helps client be better informed so he/she can fully participate in development of his/her own treatment • Use of interpreters is a cost effective means of providing services • Helps fulfill legal requirements in providing quality services • IMPROVES QUALITY OF CARE

12. George Bernard Shaw once said that Great Britain and America are two countries divided by a common tongue. An American car has: British cars have a: a trunk boot a hood bonnet a windshield windscreen and runs on gasoline and burn petrol If a British gentleman asks a lady for a rubber, he only desires an eraser. And when he promises to knock her up at five, he only intends to visit her in the early evening.

13. Questions & Comments Questions/Comments Please press * 7 to unmute your phone and press* 6 to mute it again

14. Advocate Cultural Broker Clarifier Conduit Roles of an Interpreter

15. Cultural Broker A cultural interpreter or cultural broker is an active participant in a cross-cultural/lingual interaction, assisting the clinician in understanding the beliefs and practices of the consumer’s culture and assisting the consumer in understanding the dominant culture, by providing cultural as well as linguistic links. This model of interpreting services was developed out of the awareness that communication is seriously impaired by insensitivity to the role of culture in the content and manner of communication, particularly in formal interactions. Source: Bridging the Gap: A Basic Training for Medical Interpreters (1999). Seattle WA: Cross Cultural Health Care program

16. Translation vs. Interpretation • Translation is the conversion of a message from the source language into written form in the target language • Interpretationis the conversion of a message (usually oral) from one language ( the source language) into oral form in another language (the target language)

17. Models of Interpreting • Consecutive interpreting • Summary interpreting • Cultural interpreting • Simultaneous interpreting • Sight translation • Relay interpreting • Telephone interpreting • Video Monitoring Interpreting VMI

18. Relay Interpreting Client Interpreter #1 Interpreter #1 Interpreter #2 Interpreter #2 Provider

19. Would you drink this? When “Coca Cola” was first translated phonetically into Chinese, it sounded like, “female horse stuffed with wax…”

20. What an Interpret is Not • A mental health clinician, therapist or diagnostician • They should not be placed in the position of making clinical decisions • They are also not just a “dictionary”, i.e. they also bring invaluable cultural expertise to the sessions

21. Therapeutic Triad Provider Non-verbal Verbal & Non-Verbal Interpreter Client Verbal & Non-Verbal

22. Never Use a Child as an Interpreter • This places the parent in a lower status position which results in loss of face • This places the child in an emotionally difficult position of taking care of the parent • This may be asking a child to communicate information which is beyond his/her developmental capabilities, leading to feelings of incompetence

23. Never Use a Child as an Interpreter • Information may not be accurately translated • May be asking child to divulge family secrets which jeopardizes his/her relationship within the family • Child may not wish to share information but feel compelled since person asking is in position of authority

24. Identify Appropriate Language • This includes knowing proper dialect. Critical information may not be translated properly if using wrong dialect • Ask what language the person speaks, not where they are from as this may be different • Emotions/difficult concepts are usually best expressed in a native language

25. Service Provider Must be Culturally Competent! Being culturally competent is the responsibility of the provider. If a clinician is culturally incompetent ~ interpreting insensitive information only guarantees incompetence in two languages!

26. Use Trained Interpreter Only • If not properly trained, interpreter may give inaccurate information • Even if person appears to be fluent in English, technical information and terminology may not be understood and accurately interpreted • Needs to be familiar with clinical/legal/medical terms • Must be sensitive to implications of culture and how this impacts on individual's response • If not properly trained may withhold information if he/she feels it is "shameful" or damaging to client

27. Special Concerns • Allow for extra time. • Allocate appropriate resources –To not use interpreter will cost more later both financially and in quality of life. Use of interpreter is critical for quality care. • May require creative solutions to train and use interpreters for languages with limited population

28. Helpful Hints • Address comments to the individual – not only is this a sign of respect, the person may actually understand more than he/she conveys • Do not direct comments to interpreter – this ignores the individual and makes him/her feel discounted • Allow interpreter to use cultural norms in conveying message, communication styles • Speak slowly and allow interpreter to translate every few sentences

29. Helpful Hints • Ask for clarification to make sure information is conveyed and received accurately • Do not assume if person nods in agreement or says yes that he/she understands what was said • Own problem of communication - do not blame person. • Allow interpreter to use cultural norms in conveying message, communication styles

30. Helpful Hints • Clarify if person understands what has been said • Review proceedings with interpreter in advance so he/she is familiar with your expectations of interview, evaluation, etc. • Debrief with interpreter to see if there is information that needs to be clarified or may have been communicated non-verbally by individual.

31. Questions & Comments Questions/Comments Please press * 7 to unmute your phone and press* 6 to mute it again

32. Systems Issues • Develop policies that clearly outline job description • Provide adequate compensation for language capabilities of staff • Identify resources to pay for interpreting services • Require training to work specifically in mental health

33. Recommendations • Provide training to interpreters to work specifically in multicultural mental health settings • Develop job descriptions to clarify roles of interpreters and bi-lingual staff • Provide appropriate compensation for interpreting services • Provide ongoing support and supervision for interpreters

34. Challenges • What are challenges you face within your own community? • What resources do you need? • What are success stories?

35. Do You Have Interpreting Policies? Examples: • Use only trained interpreters to ensure accurate communication • Prohibit use of minor children as interpreters • Provide for bilingual differential – bilingual bonus • Provide 800 access number for languages that are not available • Determine verbal, reading and writing proficiency using standardized exams.

36. Mental Health Interpreting Project California Department of Mental Health National Asian American Pacific Islander Mental Health Association National Latino Behavioral Health Association Texas Department of Mental Health/Mental Retardation

37. Training Schedule-Day 1 • Overview of Training Objective and Schedule • Why the need for interpreters in the mental health setting • Cross-Cultural Communication • Cultural Self-Awareness • Understanding the role of Culture in Mental Health

38. Training Schedule-Day 2 • Interpreter Role and Stages of Interpreting • Models of Interpreting • Pre-session, In-session and Post-session • Code of Ethics • Self Care Techniques

39. Training Schedule-Day 3 • Mental Health Terms, Diagnosis, Services • Cultural Bound Syndromes • Mental Health Systems • Patient’s Rights • Review • Evaluations

40. Closing Questions & Comments Questions/Comments Please press * 7 to unmute your phone and press* 6 to mute it again

41. Contact Information For information on Training: A. Marie Sanchez, MHIT Project Manager National Latino Behavioral Health Association Ph: 970-532-7210; Fax 970-532-7209 msanchez@nlbha.org Lidia Gamulin, 818-386-2927 LGamulin@Gmail.com Dr. DJ Ida, 303-298-7910 National Asian American Pacific Islander Mental Health Association djnaapimha@cs.com