1. Partnering with Medical Interpreters
Interpreter/Translation Training
August 20, 2015
SF Public Library
José Martín, LMFT, CHT
Consultant/Lecturer/Professor
National Board of Certification for Medical Interpreters,
Testing Committee Member

2. Objectives
Increase your understanding about the need for trained healthcare interpreters.
Identify misconceptions about healthcare interpreting.
Become aware of the best ways to partner with healthcare interpreters in providing services to LEP patients
Become aware of regulations related to provision of healthcare interpreters

3. Why Use A Medical Interpreter?
Improve quality of care
Better health outcomes
Legal ramifications (Title VI of the Civil Rights Act)
Culturally and Linguistically Appropriate Services Standards
Health care costs

4. Regulations mandating use of interpreters for LEP patients
Federal
Title VI of the Civil Rights Act of 1964
EMTALA-Emergency Medical Treatment & Labor Act
Hill-Burton Act
Executive Order 13166
CLAS Standards
State
Medicaid Regulations
SB 853
Local Agency Requirements
JCAHO
DHS

5. The National CLAS Standards
The National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care are intended to advance health equity, improve quality and help eliminate health care disparities by establishing a blueprint for health and health care organizations

6. CLAS Standards
Standard 1 Health care organizations should ensure that patients/consumers receive from all staff member's effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.
Standard 3 Health care organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery.

7. CLAS Standards
Standard 4 Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.
Standard 5 Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.

8. CLAS Standards
Standard 6 Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer).
Standard 7  Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.

9. Role Expectations of Interpreters
Treating the interpreter as a “robot” or voice machine. The only task of the interpreter is to pass the message verbatim from one person to the other. The interpreter is not expected to give any input, cultural or otherwise. This type of interpreter may work well in court settings, but may not be the most effective model for healthcare interviews.
Treating the interpreter as a “provider”. The provider lacks confidence in working with the patient from a very different culture, and hands over the clinical judgment to the interpreter.
Treating the interpreter as a “team partner”. The provider understands that he or she brings professional expertise and knowledge in the healing process. At the same time, the provider recognizes and respects the interpreter’s expertise in language, culture, and community resources. 9

10. Suggestions from Interpreters
Make sure to greet the patient and the interpreter upon entering the room.
Look directly at the patient, not the interpreter.
Speak directly to the patient, not to the interpreter. Use first person voice—this will be how the interpreter is interpreting.
Speak at the patient’s register—interpreters are not doctors and cannot translate high register medical information into layman language. 10

11. Suggestions from Interpreters continued
Give the interpreter 25 seconds to introduce him/herself to the patient and to remind the patient of how to speak in a way that facilitates smooth, accurate and complete interpretation.
Wait for your interpreter to finish transmitting your message before beginning to speak again. Interpreting protocol for healthcare encounters requires consecutive interpretation.
Close your encounter with a patient by reviewing with the patient what tests, next steps, or prescriptions you are ordering.
Know your language limits. 11

12. The Use of Family and Friends as Interpreters
Results in omissions, substitutions, and errors in meaning that distort care
Breaches confidentiality
Creates barriers to the provider-patient relationship
Upsets familial relationships and hierarchies that are deeply rooted in culture
Is particularly problematic in the areas of gynecology, reproductive health, and sexually transmitted diseases
Inhibits mental health treatment 12

13. Problems with Using Children as Interpreters
Accurate and complete interpretation is difficult
May lack awareness of the intent of the message
Many common English words do not have language equivalents
May not understand cultural terms used to describe illnesses
Emotional Trauma for the child
Role Reversal: Parents may resent having to rely on their children to handle adult situations

14. Trained vs. Untrained Interpreters
Interpreter Skills:
Mastery of Vocabulary, Grammar and Syntax in working languages
Consecutive interpretation
Simultaneous Interpretation
Sight Translation
Interpreter Ethics:
Patient Confidentiality
Impartiality
Respect for Individuals and Their Communities
Professionalism and Integrity
Accuracy and Completeness
Cultural Responsiveness
Bilingual persons who speak two or more languages require
training in order to transfer the message accurately and
completely without interfering with the message. 14

15. Common Errors by Untrained Interpreters
Not understanding the provider’s question or statement and failing to seek clarification
Misinterpretation due to lack of adequate vocabulary to interpret culture-specific idioms,terms, and medical terminology, etc.
Omissions 15

16. FACT Interpreters must:
Be fluent in two languages
Describe and explain terms that lie outside the language system of the patient
Understand different world views
Function as a cultural broker for patient and provider 16

17. Prior to Seeing the Patient
Give background & set goals to “get on the same page”, before entering the room.
Encourage clarification .
Agree on pacing of the interpreting session. 17

18. Using Telephonic Interpreters
Use a speaker phone; do not pass a handset
back and forth.
Remember that the interpreter is blind to visual
cues.
Let the interpreter know who you are, who else
is in the room, and what sort of patient
encounter it is.
Let the interpreter introduce her/himself. 18

19. Positioning during session in person
When employing a trained medical interpreter in person, it is best to place all three, i.e., provider, patient, interpreter in a triangle so that there is flow between provider and patient, patient and interpreter, and provider and interpreter.
When accessing a Video/Voice interpreter, it is best to look at the patient and direct the communication at the patient, not the interpreter. 19

20. When using Video/Voice interpreting (HCIN)
When accessing a HCIN interpreter, it is best to look at the patient and direct the communication at the patient, not the interpreter.
Let the interpreter know who you are, who else
is in the room, and what sort of patient
encounter it is.
Let the interpreter introduce her/himself. 20

21. Interpreter Protocol
Speak directly to the patient, this means in 1st person with eye contact, as appropriate. Do NOT speak to the interpreter.
Pause as necessary.
Everything will be interpreted. No side conversations. Interpreters will interpret everything including rude remarks. 21

22. The Dialogue
Keep a comfortable pace that will allow time for interpretation.
Avoid medical jargon and idiomatic expressions to make the encounter less complicated.
Listen before redirecting.
Give full information on diagnosis, tests, and treatment.
Confirm understanding and agreement with patient to ensure compliance.
Encourage interpreter to clarify terms with you. Feel free to ask interpreter to interpret back to you whenever you are concerned about the accuracy and completeness of the interpretation. 22

23. Debriefing
Use the interpreter as a resource for you regarding cultural nuances.
Interpreters may NOT answer questions such as, “did you think Ms. Ruiz was sad, drunk, telling the truth, getting beaten by her husband, etc…today? 23

24. Ensure Accuracy and Confidentiality
Do not ask the patients to bring their own interpreter.
Do not ask another patient to help you interpret.
Do not use children or family members.
Do not use non-qualified hospital support staff. 24

25. Documentation
Each interpreter will begin the session by saying, “Hello, my name is Yvette, Spanish interpreter cc103. How may I help you?
You may need to identify on the chart that you used an interpreter and write down the name of the interpreter. 25

26. Ending Interpretation Session
Close session with a review of next steps.
Check with interpreter if there is something missing.
Check with patient if he/she understands clearly what are the next steps. 26

27. Linguistic Issues
Patients who are Limited English Proficient (LEP) may be unable to communicate effectively with their health care provider, seriously compromising quality of care
Many LEP patients rely on family and friends to serve as interpreters.
Using anyone other than a trained medical interpreter violates confidentiality, at risk of errors, may jeopardize patient safety, and affect quality of the interaction. 27

28. SUMMARY
There are regulations mandating use of interpreters for LEP patients/clients
This is a quality of care and safety issue
Work with the healthcare interpreter to set pace of interaction with patient
Treat the healthcare interpreter as a “team partner”
There is a department policy on language services for LEP patients/clients
Using anyone other than trained medical interpreter violates confidentiality, at risk of errors, may jeopardize patient safety, and affect quality of the interaction 28