Linguistic Services & Working Effectively with an Interpreter Kathy Bondoc, MSW October 22, 2015 Delivering Culturally Competent Patient Education and Care to Tuberculosis Program Clients October 22, 2015 Austin, TX EXCELLENCE EXPERTISE INNOVATION Kathy Bondoc, MSW has the following disclosures to make: No conflict of interests No relevant financial relationships with any commercial companies pertaining to this educational activity 1
Linguistic Services & Working Effectively with an Interpreter Kathy Bondoc, MSW COSA Metropolitan Health District City Chest Clinic 3 Linguistic Competence Definition: The capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences; including persons: of limited English proficiency; who have low literacy skills or are not literate; individuals with disabilities; those who are deaf or hard of hearing. 4 2
Why care about linguistic competence? Communication barriers are associated with: Increased medical errors Lower adherence to treatment and follow-up Increased mortality Higher costs 5 Linguistically Appropriate Services Federal law requires that linguistic services be provided. Patient-related materials and signs must be available in the languages of commonly encountered groups. Language assistance services are to be provided at no cost to patients at all points of contact, in a timely manner during all hours of operation. National Standards for CLAS. Federal Register 65(247), 80865-80879 6 3
Texas Department of State Health Services Linguistic Services Standards of Care The following will be documented in the agency's client record. All intake and eligibility documentation, to include at a minimum Proof of residency Verification of financial information Client demographics Documentation of provider need/request for linguistic services Documentation of services provided to the client www.dshs.state.tx.us/layouts/contentpage.aspx?pageid=34561&id=8590001019 &terms=linguistic 7 Updated August 31, 2015 Texas Department of State Health Services Linguistic Services Standards of Care The following will be documented by the agency giving linguistic services: Number and types of providers requesting and receiving services Number of assignments Languages involved Type of services provided (oral interpretation, written translation, sign language and whether interpretation was for an individual client, family, or group) www.dshs.state.tx.us/layouts/contentpage.aspx?pageid=34561&id=8590001019 &terms=linguistic Updated August 31, 2015 8 4
Identifying Language Barriers Identifying language barriers and determining individuals likely to benefit from an interpreter is challenging but becoming increasingly necessary in clinical practice. The easiest language barrier to identify is a complete language barrier. Accurately identifying more subtle language barriers can be difficult. 9 Identifying Language Barriers Simply asking a client to report their language preference does not always work. Why? Patients may not fully understand the meaning of prefer or language preference So what do you do? Use a combination of questions 10 5
Questions to Assess a Language Barrier Question type Selfreported language proficienc y Selfreported ability to communic ate Selfd How the question is asked How well do you speak English? How easy is it for you to tell a doctor or nurse what the problem is? If your medical ld b List of response choices Fluent Very Well Well Fairly Well Poorly Cannot speak Very easy Not easy, I need some help Not easy, I need a lot of help Very difficult, not able to speak English A l h Categorize as a language barrier if the response is: Well Fairly Well Poorly Cannot speak Not easy Very difficult Any language11 th th E li h Working with Interpreters Prior to Seeing the Client (1) Give the interpreter a bit of background information & set goals to get on the same page, before entering the room to meet with the client(s). Alert the interpreter to any particular concerns that you need to address regarding the client s condition. This provides the interpreter with the information necessary to make any adjustments in his/her interpreting. 12 6
Working with Interpreters Prior to Seeing the Client (2) Encourage the interpreter to ask questions and to alert you about potential cultural misunderstandings that may come up. Respect an interpreter s judgment that a particular question is culturally inappropriate and either rephrase the question or ask the interpreter s help in eliciting the information in a more appropriate way. Ask the medical interpreter for cultural clarification when needed. Example: In some countries, how a person s marital status is categorized differs compared to the US. Some countries have additional categories. 13 Working with Interpreters Etiquette Introduce yourself to the client(s) then wait a moment to allow the interpreter to introduce him/her self to the client(s) and explain his/her role. Address the patient, not the interpreter, and maintain primary eye contact with your patient. Don t think out loud Patients wonder what is NOT being interpreted and sometimes understand more than they can speak. 14 7
Working with Interpreters The Dialogue: Part 1 Keep a comfortable pace that will allow time for interpretation. Speak more slowly rather than loudly. Speak in relatively short segments, pausing so the interpreter can interpret. Give the interpreter time to restructure information in his/her mind and present it in a culturally and linguistically appropriate manner. Speaking English does not mean thinking in English. Be aware that many concepts you express have no linguistic or conceptual equivalent in other languages. The interpreter may have to paint word pictures of many terms you use. This may take longer than your original speech. 15 Working with Interpreters The Dialogue: Part 2 Avoid medical jargon and idiomatic expressions to make the encounter less complicated. What is an example of an idiomatic expression? Listen before redirecting. Give full information on diagnosis, tests, and treatment. 16 8
Working with Interpreters The Dialogue: Part 3 Confirm understanding and agreement with the client to ensure adherence. Do not hold the interpreter responsible for what the client says or doesn t say. The interpreter is not the source of the message. If you feel that you are not getting the type of response you were expecting, restate the question or consult with the interpreter to better understand if there is a cultural barrier that is interfering with communication. 17 Working with Interpreters The Dialogue: Part 4 Encourage the interpreter to clarify terms a client may use. Ask the interpreter to interpret back to you whenever you are concerned about the accuracy and completeness of the interpretation. 18 9
Do s and Don ts - Working with Interpreters Do Document the use of an interpreter on client s records or progress notes. Document the use of an interpreter when obtaining informed consent. Document when the client refuses an interpreter. Document when you are unable to get an interpreter for either face to face or phone interpretation. Do Not Do not ask an interpreter to explain procedures to patients without your presence. 19 Resource for Interpretation Making the Connection: An Introduction to Interpretation Skills for TB Control, 2nd Edition Online video PDF viewers guide Curry International Tuberculosis Center www.currytbcenter.ucsf.edu/catalogue/epub/index.cfm?tablename=mtcai& uniqueid=3 20 10
www.findtbresources.org 21 Questions? Comments? 22 11
References Karen Okrainec, Mark Miller, Christina Holcroft, Jean-Francois Boivin, Christina Greenaway. Assessing the Need for a Medical Interpreter: Are all Questions Created Equal? J Immigrant Minority Health (2014) 16:756 760. Texas Department of State Health Linguistic Services Standards of Care. Available at www.dshs.state.tx.us/layouts/contentpage.aspx?pageid=34561&id=8590001019&ter ms=linguistic The Refugee Health Technical Assistance Center. Best Practices for Communicating Through an Interpreter. Available at: http://refugeehealthta.org/access-tocare/language-access/best-practices-communicating-through-an-interpreter/ University of Minnesota Health Literacy and Cultural Competency: Working with Interpreters. Available at: http://www.cehd.umn.edu/ssw/continuinged/documents/module5/working-with- Interpreters-Reading-Guide.pdf 23 12