Transcript PPT - The Upper Midwest Translators & Interpreters Association

How to Work Effectively
With Interpreters
Photo credit: Billie Young from the book My Heart is Delicious
Workshop Goal
To improve communication with
patients with Limited English
Proficiency by learning techniques
for working with interpreters.
Interpreting Stakeholder Group, 2009
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Workshop Objectives



At the end of the session, participants will be
able to:
Describe the advantages for patient satisfaction
and safety of working with a qualified
interpreter.
Describe the requirements for reducing
language barriers.
Define the relative roles of the provider,
patient, and interpreter.
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Hold Your Breath
1/ What went wrong?
In each circle on your handout describe the
person’s behavior and the role they are playing.
2/How could this situation have been improved?
Turn your handout over and on the other side
suggest better behaviors and/or an appropriate
role for each person.
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Patients with language barriers
•
Have longer hospital stays
•
Make fewer visits and receive fewer preventive services
•
Are less likely to use or return to clinics
•
Score lower on health knowledge and understanding of diagnosis and
treatment
•
Are less satisfied
Fortier, J., & Bishop, D. “Developing a Research Agenda for Cultural Competence in Health Care, Rockville”,
MD: OMH and AHRQ, 2002.
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LEP patients who need, but do not
get interpreters
•
•
•
Are more likely to receive intravenous
hydration and to be admitted to the hospital
(Hampers and McNulty 2002)
Are at greater risk of being discharged from
the emergency department without a followup appointment (Sarver and Baker 2000)
Have more tests done, creating a higher
overall cost (Hampers and McNulty 2002)
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Use of trained professional
interpreters was associated with:
•
Lower admission rates from the ED
(Hampers and McNulty, 2002)
•
A decrease in utilization disparities for
outpatient preventive services (Jacobs et al,
2001)
•
Reduced ED return and referral rates
(Bernstein et al. 2002)
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In summary
•
Using trained interpreters can:
• Improve patients’ health outcomes
• Improve patients’ primary care utilization
• Increase patients’ perceived understanding of their
care
• Increase patient and provider satisfaction
•
Using trained interpreters may:
• reduce medical complications
• lower the cost of care in the long run
(Interpreter Services Workgroup report, Feb 2008)
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Requirements to use language
services
•
•
•
•
Quality health care
Demographics: increase in limited English proficient
(LEP) clients
Regulatory:
• Federal law (Title VI of Civil Rights Act), CLAS
Standards
• State law (Minnesota statutes)
• Accreditation mandates (JCAHO)
Financial: reduce ER use, reduce unnecessary admissions,
decrease diagnostic test costs
Like, R., et al. “Cross-Cultural Communication in Health Care: Building Organizational Capacity, HRSA and
OMH, DHHS Satellite Broadcast, June 4, 2003.
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Key ethical principles for interpreters
•
•
•
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Accuracy
Confidentiality
Impartiality
Acting in a professional and ethical manner
National Council on Interpreting in Health Care, 2004
www.ncihc.org
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Guidelines for Working Effectively
with Interpreters
Before the appointment
•
•
•
Make sure that you are working with a qualified
interpreter and not a family member or friend.
Brief the interpreter on what to expect in the
meeting, where necessary.
Plan enough time – it may take longer than an
English-only appointment.
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During the appointment
•
•
•
Expect and encourage the interpreter to avoid
spending time alone with the patient when not
providing language services.
Remember that the interpreter is required to
interpret everything said in the room – curse words,
side conversations, and ‘irrelevant’ or repetitive
comments included.
Face the patient and talk to them directly, as if you
both spoke the same language.
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During the appointment II…
•
•
•
Don’t speak too fast. Pause after each complete
thought and/or when the interpreter signals to
you to allow for the interpretation.
Ask only one question at a time. Don’t ‘chain’
your questions.
Confirm understanding by asking the patient to
repeat key information back to you.
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During the appointment III
•
•
Be aware of the education level and/or health literacy of your
patient in order to phrase your message at an appropriate
level. Avoid using acronyms and idioms.
You are communicating THROUGH the interpreter but TO
the patient. Dealing with cultural differences and the
personality of the patient is primarily your job, not the
interpreter’s. Some examples of things to keep in mind
regarding cultural and linguistic differences:
• There may be less eye contact with the patient than you
customarily expect;
• A smile or nod on the part of the patient may not indicate
total agreement.
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After the appointment
•
Debrief with the interpreter, if
necessary, about the
communication process.
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Questions?

Thank you for coming!
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Objectives of Session 2
At the end of the session, participants will be
able
to:
 Demonstrate specific techniques for working
with trained and untrained interpreters
 Identify the importance of using alternative
‘layman’s terms’ to explain medical
terminology
 Identify core competencies they have
acquired through a post-test activity
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Video Vignette 1
•
Have you experienced a situation similar to
that portrayed in this vignette?
•
What factors from the ‘cheat sheet’ distributed
in Part 1 of this training are at play in this
scenario?
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Video Vignette 2
•
Have you experienced a situation similar to
that portrayed in this vignette?
•
What factors from the ‘cheat sheet’ distributed
in Part 1 of this training are at play in this
scenario?
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Final vignette
•
How might you implement these strategies in
your work environment?
•
What challenges might you face implementing
these strategies?
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Post Test Question 1
Which of the questions below would encourage direct
communication with your patient?
a)
b)
c)
Please ask him why he came to see me today.
Are you still having stomach pains?
Fatima, could you ask her if she is currently taking
any medications?
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Post Test Question 2
Draw an arrow to
demonstrate how you might
move one of the parties out of
this positioning in order to
communicate as directly
as possible with your
patient.
INTERPRETER
PATIENT
Interpreting Stakeholder Group, 2009
PROVIDER
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Post Test Question 3
If you, the provider, feel that the communication is
being impeded by inaccurate interpreting, a good
option to check understanding is:
a) Ask the patient to repeat the information back to
you.
b) Ask the interpreter whether they are interpreting
accurately.
c) Ask the interpreter if they think the patient
understood.
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Post Test Question 4
It is appropriate to ask the interpreter’s opinion about cultural
issues:
a)
b)
c)
Whenever you are working with a patient from a different
culture.
When you are uncertain what cultural factors are at play in
the patient’s care.
When you are unable to get an explanation from the
patient him/herself.
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Post Test Question 5
Name two possible consequences when patients
with LEP are not provided a qualified interpreter.
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How might these concepts be
explained in layman’s terms?
•
•
•
•
•
Pap smear
Inhaler
CAT scan
Angiogram
Preeclampsia
•
•
•
•
Autism
PTSD
Food support
Retrospective
eligibility
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Post Test Question 1
Which of the questions below would encourage direct
communication with your patient?
a)
b)
c)
Please ask him why he came to see me today.
Are you still having stomach pains?
Fatima, could you ask her if she is currently taking
any medications?
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Post Test Question 1
b) Are you still having stomach pains?
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Post Test Question 2
Draw an arrow to
demonstrate how you might
move one of the parties out of
this positioning in order to
communicate as directly
as possible with your
patient.
INTERPRETER
CLIENT
Interpreting Stakeholder Group, 2009
PROVIDER
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Post Test Question 2
Draw an arrow to
demonstrate how you might
move one of the parties out of
this positioning in order to
communicate as directly
as possible with your
patient.
INTERPRETER
CLIENT
Interpreting Stakeholder Group, 2009
PROVIDER
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Post Test Question 3
If you feel that the communication is
being impeded by inaccurate interpreting, a good
option to check understanding is:
a) Ask the patient to repeat the information back to
you.
b) Ask the interpreter whether they are interpreting
accurately.
c) Ask the interpreter if they think the patient
understood.
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Post Test Question 3
a) Ask the patient to repeat the information
back to you.
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Post Test Question 4
It is most appropriate to ask the interpreter’s opinion about
cultural issues:
a)
b)
c)
Whenever you are working with a patient from a different
culture.
When you are wondering whether cultural factors are at
play.
When you are unable to get an explanation from the
patient him/herself.
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Post Test Question 4
c) When you are unable to get an explanation from
the patient him/herself.
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Post Test Question 5
Name two possible consequences when patients
with LEP are not provided a qualified interpreter.
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Post Test Question 5

Patients are more likely to receive intravenous hydration and to be
admitted to the hospital (Hampers and McNulty 2002)

Patients are at greater risk of being discharged from the emergency
department without a follow-up appointment (Sarver and Baker 2000)

Patients have more tests done creating a higher overall cost (Hampers
and McNulty 2002)

Patients are more likely to be admitted to the ED (Hampers and McNulty,
2002) and to return to the ED (Bernstein et al. 2002)

Patients are less likely to use outpatient preventive services (Jacobs et al,
2001)
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Q+A
Please feel free to ask
the facilitator any
questions you have.
Thanks for coming!
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Supplementary Materials

Shadowing and role play activities
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Interpreting simulation experience
•
The following exercise illustrates the dualtasking challenge of simultaneous
interpreting.
•
You don’t need to speak another language
to participate.
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What to do
•
•
•
•
The facilitator will read you an English text.
As the facilitator reads the text aloud you should try
to quietly repeat out loud EXACTLY what s/he
says, lagging behind the original speaker by a few
seconds.
You should try to make your speech as smooth as
possible.
Again, you should repeat EVERYTHING the
facilitator says.
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Role-play Activity
Participant 1: Interpreter
Participant 2: Provider
Participant 3: Patient
You will be observing an improvised provider-patient
interaction, in which some of the typical challenges of
triadic communication (without a trained interpreter) occur.
Observe this role-play and call “freeze” when you see a
challenge for the provider. Then, as a group, you will need
to decide how best to respond to the situation.
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Role-Play Questions

Which standards of the interpreting
profession were not adhered to in this
case?

What could the interpreter, client (and
perhaps the provider) have done differently
to improve the communication?
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Supplementary Materials: FAQs
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How do I know if my patient needs an interpreter?
What is the difference between working with a
telephonic and an in-person interpreter?
Are interpreter services reimbursed? If so, how?
How can my interpreters get trained?
Why has the need for interpreting services occurred?
What is the difference between translation and
interpreting?
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Identifying your patient’s language
needs
Some points to consider:
•
•
The patient may not be able to talk comfortably about
the complexities of health care even if they are
proficient in ‘conversational’ English. In order to save
face patients may claim to understand more than they
actually do.
The patient may not know that they have a right to an
interpreter, or may think that they will have to pay
extra for interpreting services.
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Continued…
•
•
It is often awkward for reception staff to ask
patients about their language proficiency, and
difficult for either the staff or patient to assess
English language skills.
A screening question such as “In which
language would you prefer to receive your
medical care?” can garner more accurate
information than “Do you need an
interpreter?”
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Working with telephonic interpreters
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•
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A dual handset telephone should be used for decent sound
quality. Ensure you have the necessary number and, if
necessary, access code(s).
Minimize background noise
Many of the techniques for working with in-person and
telephonic interpreters are the same. For example, always
speak directly to the patient.
When working with a telephonic interpreter it is important
to brief the interpreter by introducing everyone present in
the room and stating the purpose of the encounter before
starting the conversation.
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telephonic interpreting continued…
•
•
•
Telephonic interpreting can be extremely useful for short
calls to and/or conversations with patients. It is certainly
preferable to use a phone interpreter rather than family
members, friends, or other unqualified bilinguals.
The phone is not suitable for certain situations, including
giving bad news, mental health, teaching scenarios requiring
physical demonstration, and times when the patient cannot
use the phone easily.
Video interpreting technology is opening up new
possibilities in the area of remote interpreting.
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Interpreter Services Reimbursement:
Minnesota Law
256B.0625 COVERED SERVICES
Subd. 18a. Access to medical services
(d) Regardless of the number of employees that an
enrolled health care provider may have, medical
assistance covers sign and oral language interpreter
services when provided by an enrolled health care
provider during the course of providing a direct,
person-to-person covered health care service to an
enrolled recipient with limited English proficiency
or who has a hearing loss and uses interpreting
services
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MA Fee-for-service Policy
This policy applies to Fee-for-Service MA and
MnCare enrollees
For enrollees of managed care plans contact the
individual health plan for coverage policy
Any questions contact
MHCP Provider Relations
(800) 366-5411 or (651) 431-2700
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MA Fee-for-service Policy
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
Providers are responsible for arranging and paying the
interpreter.
Providers are encouraged to use the same principles when
hiring, contracting or arranging for interpreting services.
Provider’s office staff members competent in spoken
language interpretation may interpret the medical service and
are reimbursed.
Interpreter services provided to the parent/guardian when
the patient is a minor are reimbursed.
Providers are encouraged not to use family members and are
not reimbursed if they do so.
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MA Fee-for-service Policy






Interpreter services provided during a covered medical service
are reimbursed.
Three people must be present for the service to be covered (but
the interpreter can be on the phone)
Bill only for direct face-to-face/video/phone service time
Use HCPCS code T1013 (1 unit= 15 minutes)
MHCP payment rate is the lower of $12.50, or the usual and
customary charge, for each 15-minute unit
Bill DHS directly for dual eligible recipients
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Interpreter training opportunities
Interpreting Stakeholder group
www.umtia.org/isg/isg.html
Program in Translation and Interpreting,
University of Minnesota
612-625-0591 www.cce.umn.edu/pti
Interpreting Program, Century College
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Changing demographics
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U.S. Hispanic Population growth
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‘Interpreter’ or ‘translator’?
Interpreting
The conversion of spoken
messages from one language
to another
Translation
The conversion of
written messages
from one language
to another
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One job, three modes
Consecutive Interpreting
Simultaneous Interpreting
The interpreter interprets
AFTER you have uttered a
sentence of a few sentences
The interpreter interprets while you
continue to talk. The interpreter
may lag a few seconds behind you
in order to understand the message
as fully as possible before
interpreting.
Sight translation
The interpreter converts a written message in one language into an oral
message in another language
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