Language Services Program

Language Services Program

Objectives Understand the importance of language services and its role in attaining equitable health. Improve patient care and safety and boost patient satisfaction. Understand how to access language services

Language Services Policy Statement If you recognize or have any reason to believe that a patient, relative, close friend or companion of a patient is deaf or hard of hearing, you must advise the person that appropriate auxiliary aids and services, such as sign language and oral interpreters, TTY s, note takers, written materials, telephone handset amplifiers, telephones compatible with hearing aids, and a video remote interpreter with captioning or closed caption decoders, will be provided FREE of charge if such aids or services are necessary to ensure effective communication. If you are the responsible health care provider, you must ensure that such aids and services are provided when appropriate. All other personnel should direct that person to the appropriate Program Administrator at the Center for Health Equity and reachable at 860-714- 5748. Link to the Language Services Policy and Procedure: Language Portal

What does the program include: Changes that have been put into place to enhance our services include: o Re-training sessions for units or departments throughout the year. o A language services resource box available on the units and at several departments. Each box is equipped with language services materials (including a cordless hand set or a dual handset phone pre-programmed to call the telephonic interpretation line) o New and/or updated MARTTI carts, software and distribution system o Continuous training for all medical staff, volunteers and contractors o Training for all new employees o Annual Healthstream Training for new and current Employees o Evaluation of program outcomes

Background 28 million people in the U.S with a hearing loss 322 languages are spoken in the U.S., ranging alphabetically from Abnaki to Zuni. Eight percent of Americans, or 21.3 million persons, are limited in English proficiency (LEP). An estimated 21.6% of Connecticut s population 5 years and over speak a language other than English at home. 1. The National Institute on Deafness and Other Communication Disorders 2. The US Census Bureau

Regulations that guide the provision of Language Services The National CLAS Standards 15 standards with three key intentions 5 standards are Language Services related 1 Advance Health Equity 2 American with Disabilities Act Overview Americans with Disabilities Act (ADA) ADA 2010 Improve Quality 3 Section 1557 Help Eliminate Health Care Disparities

Overview of Language Services Saint Francis now offers a collection of FREE services to provide language interpretation and translation of documents that can help patients who are deaf or hard of hearing, have a speech disability or have limited English skills. The resources are referred to as the 3 +1 Options and are currently offered by three vendors. Interpreters and Translators (iti) offers telephone interpreting; in-person interpreters and translation of documents through an in-house request system. MARTTI provides video remote interpreting with the MARTTI via a secure internet connection. LifeBridge Community Services For the Deaf & Hearing Impaired provides faceto face or "live" nationally certified, state registered interpreters for areas such as American Sign Language, Lip Reading, CDI Interpreting, and Written Communication.

Overview of Language Services 3 +1 Options Interpreters and Translators (iti) MARTTI LifeBridge Community Services For the Deaf & Hearing Impaired-

Overview of Language Services Qualified interpreter who discerns the best mode of communication which bests fits the consumer. o American Sign Language (ASL) o Pidgin Signed English o Live Interpreters can readily sense if the source language is truly understood by the deaf consumer and had the ability to take advantage of visual cues. o Written Communication: Brief notes back and forth is only to be utilized temporarily to avoid potential misunderstandings. o Lip Reading: A common misconception is that all deaf people read lips fluently. Only about 30% understand what is being said. o CDI Interpreters: A Certified Deaf Interpreter is one who is likewise deaf and is specially trained to work with those who don t use standard ASL. A CDI is most useful for patients from other countries.

Interpretation & Translation Interpretation Translation Renders a message spoken or signed from one language into another. Converts written text from one language into another.

3 + 1 Options Video Remote interpreting Level 2 Interpreting- Intermediate/time sensitive. Examples: Deaf patient, procedures, routine surgery, informed consents, medication instructions, rehab treatment sessions, social work assessments In-person interpreting/ ASL or CDI Level 3 Interpreting- Complicated or sensitive situations. Examples: Deaf Patient, fetal demise, end of life discussion, sexual assault/child abuse, trauma, conscious sedation procedures Telephone-based interpreting Level 1 Interpreting- Basic, short and uncomplicated situations. Examples: Routine return visit registration/admitting Triage, pharmacy Refill, blood Draw/Lab 3 +1 Options includes: Written translation of vital and non-vital documents.

3- Interpretation Options Telephone interpretation- 3 way telephonic communication connecting the patient and provider with an offsite interpreter. Video interpretation- also known as MARTTI (My Accessible Real Time Trusted Interpreter) Used to interpret via video connection with an offsite interpreter. Can be used for American Sign Language (ASL) In-person interpretation- Onsite interpreters are available in over 80 languages including ASL. Interpreters should be requested ahead of time based on patients schedules.

Requesting Language Services Hearing Impaired Dial 0 Provide: Unit/Department (including floor & room), date, requestor s name, patient name For Video: Operator will request a MARTTI to be delivered to you For in-person: Operator will schedule for an in-person interpreter. Please call ahead if possible (interpreters are not on-site). In the meantime, request a MARTTI while you wait if needed. o In-person interpreters should be requested ahead of time for all patients in need of in-person interpreter. Limited English Proficient Dial 0 for the St. Francis operator if you are on-site. If off-site, call the operators directly to request a telephone or a video o (Units with a dual handset phone or cordless hand set may call iti call s center directly for interpreting services if they can dial out of the hospital/unit) Operator will coordinate the delivery of a phone or video

+1 - Translation Option Other Resources- Critical Communicator cards Assistive listening device Large Button Telephones Braille Telephones Shared drive Document Translationall translation requests will go through iti s secure registration portal.

Steps to translate documents Log in at https://login.ititranslates.com/ Username: SAINT FRANCIS HOSPITAL (case sensitive) Password: SaintFrancis1030! (case sensitive- please type in password, do not copy & paste) 1. Click on Request a quote in the Quotes box on your Dashboard (middle of page) 2. Choose a requested delivery date 3. Name the project Please try to be specific ex. Ebola Flyer vs Flyer 4. Please include the following in your description: - Requested By: Your Name (If this is not filled out, we will not be able to create a quote because we will not know who is requesting the project) - Account Code # 6213037 - Any special information that we should know

Language Service Resource Box In the box Cordless or Dual Handset phones Language services waiver form- English Language Resource Box sign-out sheets Critical Communicator cards Quick Telephonic Reference Guide Additional items My Language Guide MARTTI Training checklist iti Language Identification Language Services Options How to request language services Interpretation levels

How to work with an interpreter 1) Allow for interpreter introductions Inform interpreter of special circumstances i.e. dementia, end of life discussions 2) Look and speak directly to your patient Your conversation is with your patient not the interpreter 3) Speak to your patient in the first person I 4) Pause often and speak slower in full sentences 5) Document the use of an interpreter You MUST document everytime an interpreter is used during a patient s course of treatment

Language Services Interpreter flow sheet in EPIC Needs to be used to document each interaction with an interpreter/interpretive device.

Language Services Interpreter Note in EPIC Needs to be used to document each interaction with an interpreter/interpretive device.

The Cycle of Poor Communication Language skills Still emerging ( for children) Not balanced may add, omit or change information) Emotional toll Conveying bad news Impact on family relationship Responsibility Social impact Privacy Provider use of basic language skills to get by. Cultural beliefs and traditions that affect care delivery, such as expression of pain, respecting authority, gender roles, and class biases.

Prohibited interpretation/translation Google Translate: Phone Apps CANOPY Medical Translator

Language Services Waiver Language Services Waiver: A companion/representative may be used to interpret or translate information to the patient under the following circumstances: 1) There is an emergency or an imminent threat to the safety or welfare of an individual or the public 2) There is no interpreter available 3) To facilitate patient registration and assist with assessment of need for communication services 4) Or, if the patient specifically requests the companion to serve as an interpreter and a waiver for services is signed and filed in the medical record *waiver can be found on the language services share point*

Shadow Interpreter There are times when a patient will insist on using a companion instead of a qualified medical interpreter. This may lead to dangerous situations (misinterpretation). The use of a companion can also lead to familial influence rather then informed consent. Patients have the right to use a family member or friend instead of a qualified medical interpreter. However, care providers also have the right to understand and use what is called a Shadow Interpreter to ensure best practice in medical interpretation, and to make sure your information is medically and culturally correct. You can use your interpreter to listen in to the conversation as the companion interprets the conversation. Your shadow interpreter will then listen to ensure the quality of the conversation and the information conveyed. If there are issues with the conversation, your shadow interpreter can intervene, make a clarification, and move back to a passive listening position.

Frequently Asked Questions Can a bilingual or multi-lingual staff interpret for patients even though they are not the patient s practitioner? o Staff members who are bi or multi-lingual have to be a Qualified and/or Certified Medical Interpreter in order to legally interpret for patients regarding their medical care. Are there any Joint Commission standards that prohibit a bilingual practitioner (nurse, physician, etc.) from communicating directly with a patient in their preferred language while providing care without the presence of an interpreter? o There are no standards that prohibit a bilingual practitioner from communicating directly with a patient in another language while providing care, treatment or services. How do we work with consents? o The Best Practice is to have the provider who is familiar with the document read the document, pausing for normal qualified medical interpretation. The patient can then ask questions and the provider-patient relationship is preserved. Can one request an interpreter of a specific gender? o Yes you can, there are cultural and preference issues affecting the request for a male or female interpreter. There may be times when the interpreter of the gender desired may not be available. For video interpreting, if this happens, you can use the privacy settings by closing the shutter on the camera, muting the video or simply moving the camera away for privacy.

Summary Interpretation = verbal communication Translation = written materials Three levels of interpreting Basic Intermediate Advanced 3 +1 Options Telephone-based interpreting Video Remote interpreting (VRI-MARTTI) In-person interpreting Written translation of vital and non vital documents Dial 0 for the St. Francis operator if you are on-site. If off-site, call the operators directly. Do NOT use family members or friends as interpreters unless the patient requests to use them and signs the waiver. Do NOT use non-approved interpretation or translation services. Always document every time you use any of the language services (3 +1) options