Welcome!

1. Welcome!

2. How to Effectively CommunicateThrough an Interpreter Adelya Carlson Director, Training and Outreach Northern Virginia AHEC Welcome!

3. NV AHEC • Community-Based Non-Profit • Part of Nationwide Network Mission: To Support the Health Care Workforce which Serves Vulnerable Populations

4. Objectives At the conclusion of this session, you will : • Know the difference between interpretation and translation • Understand regulatory requirements as they relate to language • Recognize the importance of using trained interpreters • Know what to expect and how to manage an interpreting encounter

5. Shadowing Exercise Pair Exercise • Choose a role (Reader/Interpreter) • The reader will read each sentence and then pause for the interpreter to “shadow” • Without looking at the paper, the interpreter will repeat what the reader says in English. • When Interpreter #1 has finished shadowing the first paragraph, switch roles. Was this exercise challenging? Why?

6. Interpretation vs. Translation What is the difference between interpreting and translating?

7. Interpretation vs. Translation Interpretation • Transmission of an oral message in one language into an oral message in another Translation • Transmission of a written message in one language into a written message in another

8. Why are we here? While English is the predominant language spoken in the United States, there is a growing number of persons who speak English “less than well” or who are “Limited English Proficient” (LEP)

9. Who is a Limited English Proficient (LEP) Person? An LEP individual is a person who; • Does not speak English as their primary language • Has a limited ability to read, write, speak or understand English

10. True or False? • Most LEP persons are poor, immigrants or minorities • Most people with Limited English Proficiency have low IQs • People with Limited English Proficiency have trouble reading • People with Limited English Proficiency have low education levels

11. Why do we need Trained Interpreters? • As a Result of Changing Demographics • To Abide by Regulatory Requirements • To Manage Risk • To Ensure Quality Service

12. Changing Demographics

13. Changing Demographics • 2000 US Census: Over 200 different languages are spoken in the US • In the past 10 years this number has greatly increased “Who speaks a language other than English when at home?”

14. 2006 American Community Survey 19.7% of US residents over age 5 speak a language other than English at home. • More than 45 million people Of this population… • 8.7 % speak English “less than very well” • More than 11 million people • 27% live in “linguistically isolated households” (households where no member 14 years old and over speaks “only English” or speaks English “very well”)

15. Changing Demographics in Virginia “What about in your area?”

16. Most Common Languagesin Virginia:

17. Regulatory Requirements Which laws apply to organizations receiving federal funds in connection to language?

18. Title VI Video

19. Title VI of the 1964 Civil Rights Act • Applies to any federally funded institution or program • Health and Human Service Organizations • Prohibits discrimination on the basis of race, religion, sex, or national origin • Insures equal access to services provided by those institutions and programs

20. To Whom Does Title VI Apply? “Covered entities” include all recipients of federal financial assistance through: • Grants • Loans • Contracts • Training • Use or donation of equipment or property • Indirectly through state agencies, county agencies, private agencies

21. Title VI of the Civil Rights Act of 1964 Recipients of federal financial assistance shall not: • Deny an individual a service, aid, or benefit • Provide a benefit, etc. which is different or provided in a different manner • Subject an individual to segregation or separate treatment

22. 2000 Executive Order 13166Title VI of the 1964 Civil Rights Act • Courts consistently rule “national origin” provision covers people with limited English proficiency (LEP) • Insures access to interpreting services free of charge • Discourages use of family, friends and minors as interpreters • Stresses the importance of language testing and training of interpreters

23. How to comply with Title VI • Identify LEP persons needing assistance • I Speak cards • Take language assistance measures • Interpretation services • Translation of “vital” documents • Train staff • LEP policies and procedures • How to communicate effectively through interpreters • Provide notice of services to LEP population • Bilingual signage

24. Language Service MeasuresInterpreter Service Options • Staff interpreters • Bilingual staff • Contract with an interpreter service • Use telephone interpreter service • Volunteer or Community interpreters

25. Possible scenarios that could violate Title VI • A Handout • Read each scenario • Determine how the scenario violates Title VI of the Civil Rights Act

26. HHS LEP Policy Guidance • Clarifies the principles of Title VI with respect to LEP persons • Details reasonable policies and procedures to ensure meaningful access of services by LEP persons Copies are available on OCR’s website www.hhs.gov/ocr

27. Risk Management

28. Managing Risk According to American Academy of Pediatrics: • The Untrained Interpreter makes an average of 31 errors during a 15 minute encounter • 63% of the errors made have clinical consequences

29. Common Type of Errors in Medical Interpretation • 52% Omission • 16% False Fluency • 13% Substitution • 10% Editorializaiton • 8% Addition

30. The Untrained Interpreter Video

31. The Untrained Interpreter As a result of the untrained interpreter’s Errors, omissions, additions and substitutions Medical history Drug allergies and potential drug interactions Duration, dosage, frequency of medication Complex medical terminology and concepts And because the Lack of confidentiality may cause patients to withhold important information The untrained interpreter Fails to insure accuracy, completeness, understanding Which may Lead to negative clinical consequences Misdiagnosis Unnecessary testing Inappropriate treatment However, because the interpreter is untrained Providers and patients have no basis on which to determine whether or not their messages have been completely and accurately interpreted Jeopardizing the client’s well being Exposing the provider to liability risks

32. Trained Interpreters According to National Cancer Institute of the National Institutes of Health research, trained interpreters: • Accurately interpreted most (74%) of the conversation (range: 47%-98%) • Had higher accuracy during non-technical portions of the discussion in comparison with the technical portions.

33. Quality of Service

34. Quality of Service Without interpreters: • Providers cannot do their jobs • Patients cannot access services to which they are entitled

35. Quality of Service Trained Interpreters; • Highly proficient in both languages • Bicultural as well as bilingual • Bound by Code of Ethics • Employ techniques to ensure accuracy and understanding • Knowledge of medical concepts and terminology • Understand the US healthcare system

36. The Trained Interpreter Studies show: Patients with access to a trained interpreter were more likely to: • Attend outpatient appointments • Ask providers questions • Understand options and participate in decisions • Follow medication and treatment instructions • Have better outcomes and physical functioning • Develop a trusting relationship with the provider • Be satisfied with the level of care Doctors working with trained interpreters were more likely to: • Make accurate diagnoses • Establish effective treatment plans • Understand the significance of their patients’ cultural perspectives and practices

37. The Trained Interpreter Video

38. How to Communicate Through a Trained Interpreter

39. What to Expect A trained interpreter will: • Make an introduction to all parties • Abide by the Interpreter’s Code of Ethics • Speak in the first person while transmitting a message • Utilize various modes of interpreting according to the situation • Employ techniques to address barriers to communication and ensure understanding

40. The Interpreter’s Introduction Setting Ground Rules & Managing Expectations • The interpreter will establish: • Who they are • What they will interpret • Confidentiality • To whom the client/provider should speak • Expectations regarding sentence length and pauses

41. CONFIDENTIALITY ACCURACY COMPLETENESS UNDERSTANDING CLIENT SELF-DETERMINATION The Interpreter’s Code of Ethics • ATTITUDE TOWARDS CLIENTS • ACCEPTANCE OF ASSIGNMENTS • COMPENSATION • PROFESSIONALISM • ETHICAL VIOLATION

42. The Interpreter’s Code of Ethics Prevents the interpreter from; • Discussing what takes place during an interpreting encounter Confidentiality • Giving opinions or advice Client Self Determination • Engaging in conversations with clients/providers outside of the interpreting encounter Attitude Toward Client • Remaining in a room alone with one party if the other party isn’t present Attitude Toward Client • Accepting compensation directly from the provider/client in the form of gifts, tips, services, etc… Compensation Requires the interpreter to; • Interpret everything that is said in the room Completeness • Provide all sight translations in the presence of the provider Understanding • Ensure that the client/provider have understood the interpreted message Understanding • Withdraw from an encounter if a violation of the Code of Ethics occurs during an encounter Ethical Violation

43. Narrative Mode and PostureFirst Person, Gaze Low When transmitting a message during an interpreting encounter, the trained interpreter: Utilizes the First Person • Promotes accuracy and understanding • Is more efficient • Makes clear the interpreter is not the source of the message Maintains a Low Gaze • Reinforces that the interpreter is not the source of the message • Reinforces interpreter's role as a conduit, strengthening client/provider relationship

44. 4 Modes of Interpretation Consecutive (Most Common) • With pauses for the interpreter to interpret • Parties must engage in a direct exchange of dialogue Sight Translation • Transmission of a written text into an oral message • Parties must process written information in a foreign language Simultaneous • Interpreting at the same time the speech is being made • One person addresses a large group • A person can’t or won’t stop talking Whispered Simultaneous • Interpreting in the simultaneous mode in a whisper • Only a few group members don’t understand a message being presented to a group • Audio equipment is not available

45. Interpreting Techniques Addressing Barriers to Communication & Ensuring Understanding Intervening • Linguistic Barriers • Interpreter speaks in the 3rd person, gaze up Mediating • Cultural Barriers • Interpreter speaks in the 3rd person, gaze up

46. Trained Interpreter;Mediating and Cultural Awareness Video

47. How to Effectively Communicate Through a Trained Interpreter • Following ground rules laid out by the interpreter during the introduction • Speak directly to the patient • Pause frequently • Use First Person • Check for understanding

48. How to Communicate Effectively Through an Untrained Interpreter

49. The recipient should take reasonable steps to determine whether the untrained interpreter: Is proficient in both English and another language Has knowledge of specialized terms or concepts appropriate to the need Understands the need for confidentiality and impartiality Is able to fulfill the role of interpreter without deviating to other roles Assessing Interpreter Competency

50. Guiding the Encounter;Communicating through an Untrained Interpreter Video