Interpreter Services. How to Effectively Work with Interpreters and Translators to Communicate with Your Patients. UWMC Interpreter Services 1

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1 Interpreter Services How to Effectively Work with Interpreters and Translators to Communicate with Your Patients UWMC Interpreter Services 1

2 What Are UWMC Interpreter Services? l We help provide equal access to medical services for over 60 different language groups l We offer several communication modes: inperson, telephonic, video, written l We provide coverage to over 87 units, inand out-patient, 24/7. UWMC Interpreter Services 2

3 Why Have Interpreters? l Equal Access is UWMC policy, and is mandated by Law Title VI of the 1964 Civil Rights Act 1973 Rehabilitation Act 1990 Americans With Disabilities Act (ADA) RCW Revised Code of Washington, Chapter Washington State Law Against Discrimination UWMC Interpreter Services 3

4 Why a Certified Interpreter? l A Professional Medical Interpreter Is: Proficient in language, terminology, technique Impartial, Guided by the Code of Ethics Certified in the State of Washington UWMC Interpreter Services 4

5 Why Not Use Services of a l A Family Member: Family Member? May add or subtract content or emotion Will likely not have necessary familiarity with medical procedure and terminology May have his own agenda Does not protect the hospital and patient by impartially assuring complete communication l Provider does not know for sure what the patient knows UWMC Interpreter Services 5

6 Why Not Rely on Patient s Language Skills? l The Limited English Proficient patient: may miss a lot of the detail in a normal encounter due to limited language abilities may feel pushed to speak English because of a wish to please, to be helpful l Both Provider and Patient may be unaware of misunderstandings due to language problems UWMC Interpreter Services 6

7 Why Not Use Staff? l No assurance of language competence. l No assurance of knowledge of medical terminology or concepts l Staff has other duties to perform l Staff cannot accompany patient through entire episode of care, such as making new appt., pharmacy, lab. UWMC Interpreter Services 7

8 Good Practices l Do not dismiss interpreter: retain, consult l Assure that this patient has no grounds for claiming that he did not have l access, or l knowledge about his care l Document any unusual circumstances in chart l Document the interpreter s presence on the written consent form, and in chart at every encounter UWMC Interpreter Services 8

9 Modes of Interpretation l In-person interpretation Consecutive interpreting (clinical encounters) Simultaneous interpreting (for classes only) l Telephone interpretation l Video remote interpretation UWMC Interpreter Services 9

10 Roles of the Interpreter l UWMC staff interpreters are part of the care team l The interpreter may act as: Conduit passing information with complete content and meaning Clarifier assuring understanding of content Culture Broker bridging cultural gaps Navigator/Advocate helping patient get his needs met UWMC Interpreter Services 10

11 The Interpreter s Role l The patient-provider relationship is supported by the interpreter. l The interpreter remains as transparent as possible, no side conversations. l The interpreter supports the patient throughout his entire episode of care, before and after the encounter with the provider UWMC Interpreter Services 11

In an Interpreted Visit: Do l Greet and address the PATIENT directly. l Establish rapport as you normally would. l Speak clearly and succinctly, with frequent pauses for interpretation.

12 In an Interpreted Visit: Do l Greet and address the PATIENT directly. l Establish rapport as you normally would. l Speak clearly and succinctly, with frequent pauses for interpretation. l Position parties so that you have eye contact with the patient. l Brief the Interpreter ahead of the session if you expect to give the patient serious news. UWMC Interpreter Services 12

DO (cont.) l Be responsive if the interpreter seeks to brief you about something before or after the session. l Head off family or friends wanting to act as interpreters.

13 DO (cont.) l Be responsive if the interpreter seeks to brief you about something before or after the session. l Head off family or friends wanting to act as interpreters. Know the APOP, 60-1: Providing Equal Access to Health Care for Patients Who Are Unable to Communicate in English l Allow the interpreter to introduce himself and explain how he will interpret. UWMC Interpreter Services 13

14 Interpreted visits: Do l Check the patient s understanding of your conversation by asking him to repeat back l Clear the room of relatives, for privacy, to ask who the patient wants present. l Let the patient know how to reach you. l Assess the patient s cultural identity, to assure appropriate care. UWMC Interpreter Services 14

15 Interpreted Visits: Do l Partner with the patient: How can we serve him best? l Give the interpreter a chance to tell you if there is a gap in understanding. l Take your cue from the interpreter if the patient s literacy level or technical sophistication is such that he cannot grasp your presentation. Reduce register. UWMC Interpreter Services 15

16 Interpreted Visits: Don t l Ask the interpreter his opinion of the patient. l Hand the interpreter material to explain to the patient and walk out. l Assume that the patient s body language means the same as your own. l Dismiss the interpreter. l Act as your own interpreter unless you are certified or native in that language. l Make comments in a foreign language that you would not make in English. ( Cerveza ) UWMC Interpreter Services 16

17 Consents for Care l The Consent for Care should be presented to the patient by the provider orally. l The Interpreter will interpret your explanation of the highlights of the consent. l Document, on the Consent form, the presence of the interpreter. l Document that the patient was able to repeat back the highlights of the plan. UWMC Interpreter Services 17

18 In-Person vs. Telephonic l In-person for high-acuity, telephonic not practical: Invasive, high-risk procedure. Care conference with many participants. Patient not able to communicate via phone. l Telephonic recommended: Most routine interactions Most unscheduled communication sessions Speed imperative: triage needed, consent needed Uncomplicated, brief exchange of information l Mixed: telephonic to get started, in-person to carry through extended episode of care, ex: emergency visits Note: For many languages, an in-person interpreter is not available at all. In these cases, telephonic or video is used even for high-acuity situations. UWMC Interpreter Services 18

19 Translations Available l Documents specific to your patient Letters, treatment plans, individualized med lists or instructions, incoming Path reports, etc. Request through Interpreter Services. l General-use documents/instructions Learn how to use Health on Line! l Keep track of how often you hand out a documents in English to patients who don t read English. Request patient education translations through Patient and Family Education Services. UWMC Interpreter Services 19

20 Cultural Consultation l Common issues End-of-life decisions/ Advance Directives Non-compliance with treatment plan Family dynamics/ non-disclosure of Dx l Resources Ask the patient! Interpreters, anthropologists, community members, elders, health librarian UWMC Interpreter Services 20

21 Deaf, Deaf-Blind Patients l Each person has specific needs and preferences for communication. Ask the patient. l Ask about interpreting needs - ASL, Close Sign, Tactile, Signed English, written English. l Do NOT assume that the patient reads or speaks English. ASL is a different language. l Consider lighting, patient sight lines, and use of hands, which are critical to communication. l Lip reading and family interpreting are NOT acceptable for clinical communication. UWMC Interpreter Services 21

22 Deaf Patient Access l Plan ahead for interpreter support, and for assistive device availability: resources rare. l Coordinate closely with Interpreter Services. l Minimize last minute changes. l Make special arrangements for surgery scheduling. l Partner with the patient to build a communication plan for ongoing care: , video relay, texting to smart phone UWMC Interpreter Services 22

23 Contact Interpreter Services l Phone Phone forwards to Admitting at 5 PM l intrpsvc@u.washington.edu l Fax l Walk-in: EE745 Pacific Tower 7E l Box l Intranet site: interp/pages/default.aspx UWMC Interpreter Services 23

In this chapter, you will learn about the requirements of Title II of the ADA for effective communication. Questions answered include:

1 ADA Best Practices Tool Kit for State and Local Governments Chapter 3 In this chapter, you will learn about the requirements of Title II of the ADA for effective communication. Questions answered include: