1 Working with an Interpreter Online Education Children s Hospital of Wisconsin
2 This presentation will help you Understand the role of an interpreter Work effectively with an interpreter Access interpreter services at CHW
3 Imagine You are passing through the Skywalk and see a family who appears to be lost. You stop to help them and realize they don t speak English. What do you do? You are caring for a patient whose parents only speak Laotian. They ring the call light at 7 p.m. How do you communicate? Read on to learn how to match service and communication solutions to these scenarios.
4 In the United States More than 10.5 million adults speak little or no English (4 million more than in 1990) More than 6.6 million speak Spanish (over 3.28% of the population) More than 1.2 million speak Indo-European languages Over 1.4 million speak an Asian or Pacific Islander language Source: DHFS and DWD Civil Rights Compliance Training, September 2003.
5 What is an interpreter? An interpreter is a person who orally converts the spoken word from one language to another, either in person or over the telephone. Source: Jacobs EA and Goldin GL (2002). A Volunteers in Health Care Guide to Overcoming Language Barriers, Pawtucket, RI: Volunteers in Health Care.
6 Interpretation vs. Translation: What s the difference? Interpretation is spoken. Translation is written.
7 What does an interpreter do? The fundamental purpose of a healthcare interpreter is to facilitate communication between two parties who do not speak the same language and do not share the same culture. Note: Interpreters are to communicate what you communicate. They should never function independent of another medical professional. Source: California Standards for Healthcare Interpreters. CHIA: 2002.
8 Interpreters may also Clarify messages when words or concepts may lead to a misunderstanding. Explain cultural differences to help both parties understand each other s explanations on health and illness. Advocate for patients to support change in the interest of patient health and well-being. Source: California Standards for Healthcare Interpreters. CHIA: 2002.
9 Interpreters should not Add, edit or omit statements from either party. Interject personal issues, beliefs, opinions, or biases into the conversation. Influence the opinion of patients or clients by telling them what action to take. Provide services to family members or close personal friends, except in emergencies. Source: National Council on Interpreting in Health Care,
10 Code of Ethics for Interpreters in Health Care Like many other professions, interpreters are expected to follow a code of ethics while performing their job duties. Confidentiality, accuracy and impartiality are the three most important areas of concern for healthcare interpreters. Source: National Council on Interpreting in Health Care,
11 Confidentiality Interpreters must treat all information learned during the interpretation as confidential, divulging nothing outside the treating team without the full approval of the patient and his or her physician. Source: National Council on Interpreting in Health Care,
12 Accuracy Interpreters must: Transmit the message without additions or omissions, conveying the tone and spirit of the original message. Ask for clarification or repetition of information whenever they do not fully understand or hear it. Make every effort to assure that the patient has understood questions, instructions, and other information transmitted by a health provider. Source: National Council on Interpreting in Health Care,
13 Impartiality Interpreters are not responsible for what is said by anyone for whom they are interpreting. Even if interpreters disagree with what is said, they should not add their own personal opinions, advice or judgment. Interpreters should not influence the opinion of patients by telling them what action to take. Source: National Council on Interpreting in Health Care,
14 Modes of Interpretation There are two modes or types of interpretation: simultaneous and consecutive. The main difference is the time lag, or pause, between the original speech and the foreign language version. Source: SDNY Interpreters Office: Skills: Modes of Interpretation:
15 Simultaneous Interpretation Simultaneous is real-time interpreting. Speakers talk as they normally would while the interpreter listens to one language and reproduces the same content in another, lagging slightly behind the speaker. This mode is useful to interpret for a single person in a large group, such as a patient care conference. Source: SDNY Interpreters Office: Skills: Modes of Interpretation:
16 Consecutive Interpretation Consecutive interpreting involves a pause between language conversions: first the interpreter listens to the entire original phrase or passage, then interprets it into the other language. Consecutive interpreting is the most common mode in healthcare settings because it is similar to the way people usually talk to each other and is less confusing than simultaneous interpretation. Source: SDNY Interpreters Office: Skills: Modes of Interpretation:
17 Sight Translation Sight translation is when an interpreter takes a document written in one language and reads it aloud in another language. Complex documents, such as consent forms, should not be sight translated. However, this technique can be used to read relatively simple documents, such as discharge instructions or teaching materials. Source: SDNY Interpreters Office: Skills: Modes of Interpretation:
18 Do I need to use an interpreter? Yes. According to Title VI of the Civil Rights Act of 1964 states that, No person in the United States shall, on ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance (such as Medicare and Medicaid). Source: Civil Rights Act of 1964, 42 U.S.C. Sec. 2000d (1988).
19 DHHS Requirement According to the Department of Health and Human Services (DHHS) Office of Civil Rights, Title VI assures that language be taken into account in the provision of health and human services. Source: Quality Health Services for Hispanics: The Cultural Competency Component. DHHS, HRSA/BPHC: Chapter 3, page 21.
20 Family, Friends and Children Family and friends of the patient should not be used to interpret in a medical setting because it may result in: a conflict of interest breach of confidentiality omissions, additions, substitutions, and/or other errors that could adversely affect care. Source: CHW Patient Care Policy: Language Services: Interpretation, Visual or Hearing Impaired, October 2008.
21 Family, Friends and Children Children should not interpret under any circumstances. Why? Changes family dynamics (child acting in adult role) Difficult terminology and sensitive medical information Omission of information child does not want to relay An interpreter should be requested to make sure the family has all of the information they need to know about their child s care. Source: CHW Patient Care Policy: Language Services: Interpretation, Visual or Hearing Impaired, October 2008.
22 Staff as Interpreters According to CHW s Patient Care Policy on Interpreters: Staff members who are proficient in a second language may communicate directly while providing care for patients. However, staff members are not to be used as interpreters. Source: CHW Patient Care Policy: Language Services: Interpretation, Visual or Hearing Impaired, October 2008.
23 Speaking versus Interpreting Basic conversational language skills can be used to speak with a patient or family in non-technical situations (Examples: Do you need some water?, Are you in pain?, etc.). An interpreter should be requested whenever medical information needs to be communicated (Examples: for physical examinations or procedures, to obtain consent for treatment, to give discharge instructions, etc.).
24 Speaking versus Interpreting A person who can speak a foreign language proficiently may not have the necessary skills and training to provide accurate interpretation. Qualified medical interpreters have specialized training about the role of an interpreter, a code of ethics, modes of interpretation, managing the flow of a conversation, linguistic and cultural barriers to communication, and medical terminology.
25 Language Services at CHW Language services at CHW include the following: 24/7 access to interpreters in 150 languages by telephone Combination of staff interpreters and agency interpreters for face-to-face communication 24/7 Document translation service for CHW patient education materials and public relations items Source: CHW Patient Care Policy: Interpreter Services: Language, Visual or Hearing Impaired, April 2005.
26 Working with an Interpreter To assure your interaction with an interpreter is positive and effective Plan enough time for the session. Speak to the patient, not the interpreter. Expect everything to be interpreted. Be concise and pause often. Avoid slang and jargon. Check for understanding.
27 Plan enough time Schedule enough time for the appointment. An interpreted conversation requires every statement or question to be uttered twice.
28 Speak to the patient and family During the medical interview, speak directly to the patient and family, not the interpreter. Your eye contact should be primarily with the patient and family because you are talking to them, not the interpreter.
29 Expect everything to be interpreted Be sensitive to the patient s needs to be included in conversations in the room. Don t say anything that you don t want the other party to hear. If you are concerned that the interpreter has not interpreted everything, ask the interpreter to do so.
30 Be concise Group your thoughts in short, simple sentences. Pause to allow for interpretation after every two or three sentences. Remember that what can be said in a few words in one language may require more words in another.
31 Avoid slang and jargon Use the simplest vocabulary that will express your meaning and avoid: slang or jargon, technical medical terminology, changing your idea in the middle of a sentence, asking multiple questions at one time.
32 Check for understanding Confirm with the interpreter and patient that your message is understood. If it is unclear whether the message is understood, ask the patient to repeat the message in his or her own words.
33 The Languages of CHW The majority of patients and families at CHW who request an interpreter communicate in Spanish, Hmong and American Sign Language. However, there are many other languages spoken here too, including
34 Other Languages Russian Vietnamese Somali Laotian Arabic Farsi Polish Serbian Gujarati Mandingo Albanian Chinese Cantonese Mandarin
35 CHW s Language Services Program The Language Services Program provides face-toface and telephone interpretation (oral) for patients and families with limited English proficiency or who are hearing or speech impaired. Interpreters are available 24 hour a day, 7 days a week, at no cost to the patient or family. Language Services also processes requests for translation (written) of vital documents.
36 Face-to-Face Interpretation The Language Services Program at CHW provides face-to-face interpretation to patients and families through staff interpreters, temporary staff interpreters, and language agencies.
37 How do I request an interpreter during the day? For needs of 20 minutes or less, please use the phone. For needs over 20 minutes, during regular business hours, please send an interpreter consult request. It is always best to schedule the interpreter with as much advance notice as possible. Our office hours are 8:00 a.m. to 4:30 p.m., Monday through Friday.
38 How do I request an interpreter after hours? To reach a Spanish interpreter after hours, on weekends and holidays, please alpha-page the Spanish interpreter on call. Go to On Call Schedules on the CHHS intranet, and look under Spanish Interpreter-After Hours to alpha-page the interpreter on call.
39 How do I request an interpreter after hours? When you alpha-page the Spanish interpreter on call, please include the following information in your message: Your name Your phone number Your location Your need (e.g. patient in triage or patient in PICU room 8 )
40 How do I request an interpreter after hours? For all other languages after hours, you should contact the Hospital Operator (extension 2000) to request an interpreter. The Hospital Operator has a list of approved, qualified interpreters. Family Services maintains this list.
41 Telephone Interpretation Children s Hospital and Health System uses the services of Pacific Interpreters to provide access to language interpreters by telephone. Pacific Interpreters has language interpreters available by telephone 24 hours a day, 7 days a week, in over 180 languages.
42 When can I use Pacific Interpreters? Anytime, day or night to: Briefly speak to a family in person (20 min. or less). Make phone calls to parents who are at home. Cancel or reschedule appointments. Give instructions for a procedure or surgery. Communicate in an emergent situation. Begin an appointment until an interpreter arrives. Communicate when there is no interpreter available for a specific language.
43 Do I need a consult for phone calls? No. Phone calls can be made directly from any main campus phone by dialing extension Additional instructions on how to use the phone interpreter service are available on the CHHS intranet or by calling Language Services at extension 3336.
44 Should I document that an interpreter was used? Yes. If you are using the phone interpreter service, please record the ID number of the interpreter you spoke with in the patient s chart. If a face-to-face interpreter assisted you, he or she will provide you with an adhesive label. Please add the label to the progress notes of the patient s chart.
45 Document Translation The Language Services Program receives and processes requests for translation of written materials into different languages. Requests for document translation should be sent as a Service Request through the CHHS intranet.
46 CHHS Intranet Site Information about Language Services is available on the CHHS intranet. On the intranet main page, in the left margin click the Resources for Families button. Under the section with the heading Services click the Interpreters link.
47 Scenarios Following are some common scenarios regarding interpreter services.
48 She speaks a little English, so I don t think we need an interpreter. Even if the patient or parent speaks a little English, it does not mean he or she will understand everything you say, especially when medical terminology is involved. Some people with limited English proficiency may be hesitant to admit they do not understand you because they believe it would be a sign of disrespect. A person s pride may also make it difficult to admit that he or she does not speak English well.
49 How do I know the family understands me through the interpreter? A good way to check whether or not a patient or family member understood you is by asking them to repeat what was said in their own words.
50 I speak a little Spanish. I can muddle through. Communicating in a second language is a difficult task. When there is important medical information that needs to be communicated, don t over-estimate your own ability to speak the patient s language or the patient s ability to speak yours. This is why we have interpreters: To ensure accurate communication.
51 I need you to call this family for me. Whenever you need to call a family that speaks a language other than English, it should be a threeway phone call, using the phone interpreter services. You, the interpreter, and the family member should all be on the phone together. An interpreter should not be making the call alone.
52 Why can t you call them for me? An interpreter s role is to interpret what is said by both parties. If a parent has questions, the questions need to be interpreted to you, and your answers need to be interpreted back to the parent. An interpreter should not answer any questions regarding medical care or offer any advice.
53 Do you know the answers? Remember the family lost in the Skywalk? What would you do? One option is to ask the Information Desk to use the phone interpreter service to assist the family. There is also a chart at each Information Desk to help you identify the family s language. What about the Laotian family who needs help after hours? First use the interpreter phone to determine the family s needs. Second, contact the Hospital Operator for assistance if you need a face-to-face interpreter to come in.
54 Thank you! Thank you for completing the online education module: Working with an Interpreter. Please contact us at if you have any questions about Language Services. Whether it s face-to-face or over-the-telephone, use a qualified medical interpreter to ensure accurate communication.
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