1. In Person and Video Remote Interpreting Know your Facts

2. Presented by Rachel Spillane M.Ed., CSC, OTC Director of Deaf Out Reach Services

3. Interpretation Methods  Can be done by Face to Face (in person)  Can be done thru video remote  Can be done by phone  Can be written translation

4. Video Remote Equipment  Equipment and installation requirements

5. Steps of the VRI System Step One: The hospital personnel phones the VRI agency to request the VRI service Step Two: The agency then contacts the VRI interpreter with the request Step Three: The VRI interpreter places the call to the hospital contact person to ensure the equipment is in place and is ready to be used Step Four: The Interpreter then initiates the VRI connection

6. The Difference between VRS & VRI VRS VRS Phone Relay Service Phone Relay Service Controlled by FCC Controlled by FCC Can only be located in approved Centers Can only be located in approved Centers VRI VRI Video to Video Service Video to Video Service No Controls, just partnership agreement No Controls, just partnership agreement Can be located in Interpreter’s home and follows HIPAA/RID confidentiality guidelines Can be located in Interpreter’s home and follows HIPAA/RID confidentiality guidelines

7. The Difference between VRS & VRI (continued) VRS VRS Variety of Topics Variety of Topics Qualified Interpreters, does not mean certified or trained to cover all topic matters Qualified Interpreters, does not mean certified or trained to cover all topic matters VRI VRI Specialized Topics Specialized Topics Interpreters should be RID Certified and had specialized training i.e. Medical Interpreters should be RID Certified and had specialized training i.e. Medical

8. Demand vs Supply  The Sign Language interpreter pool is facing a shortage, in some areas of the country it is severe.  The shortage is due to the following reasons: Advent of VRS (Video Relay Services), dwindling numbers from training programs, the largest pool of interpreters are nearing retirement, demand from business and educational settings have increased etc.

9. Embarking on Video Remote Business  Consider equipment needs: connectivity  How to man the system  Where to place the end point systems i.e. in centers vs interpreters homes  Cost of running this type of system  Training Hospital Staff, deaf patients and interpreters  Consider Federal, State regulations, guidelines

10. Cost of running VRI  Over head costs: of hook up, T1 lines, phone lines, gate keeper, border control, paying 3 shift employees salaries  Billing costs  Equipment costs: average cost of small VRI unit is anywhere from $2500 and up  Average yearly cost of running this type of business with bare bones staffing is about $200,000 per year.  With 7 hospitals on, this is volume based business you would see of an average of $1500 a month  Most major VRI companies will tell you that they were in the red for more than 5 years before they saw a profit. Again this is volume based business

11. Importance of Developing Training Materials  Hospitals need to know how to appropriately use interpreting services  Must develop training materials that is accessible and easy to implement i.e Power Point Presentation on hospital computer system for on going training, pamphlet (1 page) that is in accessible location for staff  Must physically go to the hospitals on a periodic basis to present the power point training due to staff turnover and if staff hasn’t had the experience of requiring interpreting services (Reinforcement is Key)

12. Possible Inappropriate VRI Situations Possible Inappropriate VRI Situations TechnicalDifficulties Visual Barriers Cognitive Barriers VRI Guidelines

13. Technical DifficultiesTechnical Difficulties  VRI clarity is based on type of connection, if it is based on equipment use overall in a hospital, a power drain will produce a poor quality picture. Sometimes the picture will freeze up. The Interpreter will have to disconnect and reconnect. This may happen several times during a session.  If the settings on the VRI have been changed inadvertently you will receive no picture. Troubleshooting has to occur here to get the appropriate setting  If VRI is wireless, there could be dead zones in the hospital where the VRI will not work at all. similar to cell phone problems.  Power outage or equipment failure can occur  If troubleshooting takes more than 10 minutes, the hospital should call for an on site interpreter

14. Visual Barriers  If there is too much equipment in a room or the equipment will interfere with the use of the VRI. The VRI should not be used. An example of this would be eye exam. The exam takes place in a dark room with a lot of equipment. The equipment is a barrier for the deaf consumer to even see the VRI interpreter. Another example would be hearing test. The room is lead shielded and prevents wireless connection to the VRI unit.

15. Visual Barriers  Deaf consumer has vision loss that will prevent the person from using the VRI.

16. Cognitive Barriers  If the Deaf consumer has cognitive impairment due to alcohol/drug, or is on medication that impairs judgment, has TBI, Senility, Alzheimer, and mental illness. VRI should not be used under these circumstances.

17. Decision to use VRI or not to use VRI  The hospital personnel should always explain fully to the deaf patient when making a medical appointment about the interpreting service options. The final decision of how the communication is to be handled should always be left to the deaf person. VRI should never be forced on a deaf patient.

18. The next few slides are examples of what to include in a training power point to the hospital staff

19. Situations where the VRI is appropriate  Emergency Room-admissions information for triage to formulate treatment plan  Pre-OP, to explain procedure and to fill out hospital questionnaire, consent form etc  Prior to a routine procedure i.e. x-ray, MRI,CATSCAN, Physical Therapy etc  Short routine office visit (less than ½ hr)  Doctor’s rounds  When medical staff needs to talk to a patient who is hospitalized for an update on patient’s status  Discharge planning

20. Situations where VRI should not be used  Post operation  Equipment barriers (lead shielded rooms etc)  Patient is not coherent  Patient’s ability to use the VRI or patient’s personal preference to have on site interpreter  Emotionally Sensitive information  Complicated and Risky Procedures  Certain Mental Health situations i.e. patient is in restraints etc.

21. Mental Health  If the patient is comfortable with using the VRI for mental health status, one on one counseling etc  In groups, you have to consider the all the participants. This is probably not a good venue for the VRI. The other issue is the ability to hear who is speaking and this could pose a problem  If patient is in restraints or out of control, having auditory and/or visual hallucinations then the VRI is not appropriate

22. What the medical staff needs to know in order to facilitate communication through the VRI ~Always direct your comments to the deaf ~Always direct your comments to the deaf patient DIRECTLY. Stand next to the VRI patient DIRECTLY. Stand next to the VRI so patient can see you and the interpreter so patient can see you and the interpreter ~ Be aware that everything that is ~ Be aware that everything that is heard or seen by the interpreter will be interpreted heard or seen by the interpreter will be interpreted ~Give the Interpreter time to explain what is going to occur before you proceed with an action (i.e. insert the needle into the patient’s arm)

23. What you need to know What you need to know  Remember not to block the patient’s view of the interpreter and vice versa  If you leave the room and plan on not returning for a while, inform the VRI interpreter so they can disconnect and make arrangements for a reconnection at the appropriate time

24. Privacy Guidelines If the patient is not in a private room the following steps will need to be taken: 1. Make sure the volume on the VRI unit is turned down so other people not associated with the patient cannot hear what is being said 2. Make sure the VRI unit is not visible to others not associated with the patient 3. Limit the amount of information that needs to be stated at that point in time, until patient can be moved to a more private location

25. Advantages of VRI  Interpreters on Demand  Access to important information immediately for quick response  Better use of resources (a VRI interpreter can cover more assignments in one day than an interpreter who drives from assignment to assignment)  Pay for only the real interpreting time not the driving or down time  Interpreter is not exposed to hazardous conditions  Can be a cost savings if used efficiently  Complies with the ADA legislation

26. The following slides are examples of what you would use to train your interpreting staff

27. The Interpreting Challenge  Medical Terminology Interpretation  Language Equivalents (expansions)  Working in 2 dimensional environment has an impact on certain visual cues  Teaming  The interpreter has to make sure the lighting, contrast and visibility is clear enough on both ends  The interpreter has to be aware and notify if picture quality starts to disintegrate  The interpreter has to be aware and notify if audio levels are compromised

28. VRI Teaming with CDI  Certain patients have a compromised communication issue and will need a deaf interpreter along with the hearing interpreter  A CDI will be on site and will use the VRI Interpreter to relay the message to the patient

29. VRI Teaming with CDI  The VRI Interpreter along with the CDI interpreter will control the communication traffic to make sure the CDI has plenty of time to convey the message  The patient will not be viewing the VRI Screen, only the deaf interpreter will be viewing the screen

30. VRI Teaming with CDI  The patient will be in direct communication line with the CDI  Medical staff has to be aware not to block visual communication either by standing or putting equipment in front of the sightlines of the interpreters and the deaf patient

31. VRI Teaming with CDI  Technology is also available where both the CDI and the hearing interpreter will be on the VRI screen, in that case, the VRI screen will be facing the deaf patient and all other information listed above will still hold

32. CDI Responsibilities  CDI needs to be aware of environmental information that needs to be passed onto the VRI Interpreter  CDI needs to be aware to pass on visual cues in a subtle way as to not offend the deaf patient  When the VRI is turned off, the CDI should leave the room and establish a way for the medical staff to alert the CDI when interpreting needs arise

33. CDI  CDI in a mental health setting need to be aware of their signing affect so as not to increase the patient’s anxiety or emotional state  CDI can determine if an onsite hearing interpreter would be better suited for the situation at hand

34. CDI  CDI and VRI interpreters don’t have a way at the end of the session to talk about the teaming aspect of their work, so another method has to be utilized  CDI have to understand how to work in a 2 dimensional framework to work in a 2 dimensional framework

35. Clear Communication  Roles clearly defined  Respect  Effective Teaming (medical staff, VRI, CDI and patient  Eliminating barriers  VRI should never be forced upon a deaf patient even though it is stated that it complies with ADA (lawsuits have been filed in this arena)

36. The following slides give examples of how you train and empower your consumers i.e Deaf Patients

37. Take Charge of your Communication Process When you make a medical appointment, ask whether you will be getting an on-site interpreter or VRI. This is the time to make your preference known. When you make a medical appointment, ask whether you will be getting an on-site interpreter or VRI. This is the time to make your preference known. If you are not satisfied with how the communication is conducted (whether it is VRI or on-site interpreting), ask to speak to the Patient Relations Dept. or Nursing Supervisor. If you are not satisfied with how the communication is conducted (whether it is VRI or on-site interpreting), ask to speak to the Patient Relations Dept. or Nursing Supervisor. If unable to resolve the issue, you can file a complaint with OPA (Office of Protection and Advocacy) If unable to resolve the issue, you can file a complaint with OPA (Office of Protection and Advocacy)

38. Ask the VRI interpreter the following questions: A) What is interpreter’s name and what company do they work for? B) What is their certification level? C) Has the interpreter had prior medical interpreter training? D) Is the picture and sound quality clear

39. How to Advocate for yourself  Ask the VRI Interpreter the following questions (continued)  E) Do you understand the interpreter and does the interpreter understand you?  F) Is VRI appropriate for your situation?

40. Questions and Answer Period  Thank you for attending and hopefully this workshop gives you a plan to implement clear communication on how to effectively use interpreting services