Improving Healthcare: Specialization for Sign Language Interpreters

July 29, 2013

Quality interpreting in healthcare is a growing need in our field. Author Richard Laurion makes the case for specialization while discussing current initiatives to grow competency among interpreters working in healthcare settings.

Healthcare affects us at every stage of life; not only are we consumers of the healthcare system from before birth until the end of our lives, but healthcare has become a large part of our national discourse and consumes more of our financial resources every day.  Another increasingly common piece of healthcare is interpreting—caused in part by, recommendations from The Joint Commission (Wilson-Stronks, 2008), rules in the Affordable Care Act (Tietalbaum, 2012) and an increasing number of lawsuits brought by the Deaf Community (12 in Minnesota alone in the last 10 years).  It seems the right time for sign language interpreters to increase our focus on healthcare and ensure our effectiveness in this important area of practice.

A Growing Need

Nathan Ellis, the director of the Deaf Immigrant Center for Education (DICE) in Minneapolis, shared that one in every three encounters at the massive Hennepin County Medical Center involves a spoken or sign language interpreter.   Another indicator of this growth locally is the recent hiring of multiple staff sign language interpreters at the six largest health systems in Minnesota.  There are reports of similar increases in requests for interpreters and expansion of interpreting pools in other large metropolitan communities.

In 2012, the National Interpreter Education Center (NIEC) surveyed sign language interpreters, who identified medical interpreting as one of the most common settings for freelance/contract interpreting services.   It was also rated as the second most common setting where practitioners most urgently need training.  In my work for the Collaborative for the Advancement of Teaching Interpreting Excellence (CATIE) Center and the National Consortium of Interpreter Education Centers (NCIEC), we have found nationally that it is common for freelance interpreters to interpret in clinics without any education, training or supervised experience in healthcare interpreting.  A comparison of two earlier studies found a slight, but growing, interest among sign language interpreters wanting to specialize in medical interpreting (Cokely, 2010).  Considering these increases in the demand for interpreters and the interpreting field’s growing interest along with widely admitted unpreparedness and training needs, how are we preparing ourselves, if at all, to do this life-impacting work?

An Important Starting Point

A key aspect of optimal healthcare is the relationship between doctor and patient.  While the importance of communication in doctor-patient interactions has been well documented (Frey, 2010), the complex work of healthcare interpreters has not.  It was only recently that efforts were made to categorize the body of knowledge sign language interpreters should master before interpreting in medical healthcare settings.  The CATIE Center-led investigation for NCIEC identified the following core competencies:

  • Health Care Systems
  • Multiculturalism and Diversity
  • Self-Care
  • Boundaries
  • Preparation
  • Ethical and Professional Decision Making
  • Language and Interpreting
  • Technology
  • Research
  • Leadership
  • Communication Advocacy
  • Professional Development (www.healthcareinterpreting.org, 2008)

This list of domains and competencies is an excellent resource for beginning our development and focus in healthcare interpreting.  In addition to the list above, there are other strategies interpreters may consider for professional development and building competence.

Reflective Practice

The tendency to go into much of our work with “insufficient skills sets” was discussed by Anna Witter-Merithew in her article, Sign Language Interpreters: Breaking Down Silos Through Reflective Practice.  This concept agrees with what the NCIEC identified and interpreters report themselves (NIEC 2013).  Despite having identified a body of knowledge and skills outlined in the Medical Interpreting Domains and Competencies, individuals are largely taking on these specializations without additional preparation or supervision, perpetuating the professional isolation discussed in Witter-Merithew’s article.  We need to consciously move from this condition of isolation into a process of reflective practice, or as Witter-Merithew described, “examining critical incidents that occur within our work to gain a deeper understanding of what they mean for what we do.” She also provided a concrete list for how to actively reflect on interpreting work and decisions.  As I considered this, it struck me that I had seen concrete applications of reflective practice put into action by my colleagues in healthcare interpreting.

Improving Practice with Colleagues

In Minnesota, we take pride in our innovation and excellence in healthcare, and being home to many healthcare industry leaders.  I see this similar pride shared across the Midwest among sign language interpreters working in healthcare.  Three local groups provide excellent examples for reflective practice and use of case conferencing:

  • Medical Interpreters Consortium (MedIC) of the Twin Cities, consisting of staff interpreters working for five local health systems.  They represent a variety of perspectives from primary, secondary and tertiary care.  The focus of their discussions is on the perspectives they bring as interpreters functioning as employees in major health systems, and the various and complex ways their roles differ from those of contract interpreters. They use case scenarios to illustrate issues working within the system as a staff person and how this needs to be different for contractors not directly employed by the system.
  • Minnesota Hospital Consortium (MHC), a group of community interpreters who contract as part of a unified system established for the sole purpose of providing interpreting services 24 hours a day for urgent and emergency care needs at 21 hospitals and 8 urgent care centers across the Twin Cities metropolitan area.  MHC represents many of the same health systems as MedIC. The interpreters’ role and subsequent group discussions are uniquely focused on issues leading to improvements in their response to urgent and emergency care needs for the facilities, staff and patients.  They introduce specific scenarios to illustrate issues of concern or situations needing attention.  Through their sharing they have identified systematic problems and gaps in communication access.
  • Case Study Mentors, consisting of members in and outside of Minnesota. This is a pilot project sponsored through the CATIE Center that includes staff and contract interpreters from several midwestern communities.  The group’s focus is on using reflective practices and case studies as learning tools when working with healthcare interpreting colleagues.  The mentors meet monthly (via the Internet) with a facilitator, define a case study and then individually meet with their local group of healthcare interpreters to work through the scenario.

Each of these groups has found it effective to use case studies and conferencing as a means for reflective practice.  Each group has formed around a sole focus and perspective for their discussions.  They use strategies for neutralizing the content and “sorting out the important details and a reason for bringing it into discussion,” as suggested in Kendra Keller’s Street Leverage post, Case Discussion: Sign Language Interpreters Contain Their Inner “What the…!!!?  They have identified how to challenge each other and respectfully examine the decisions they choose. These sign language interpreters choose to further their competence and practice in medical healthcare through reflective discussion.

Engaging Deaf Experts

One doesn’t need a formal group to do this reflective work with colleagues.  In Minnesota, we are also fortunate to have Deaf Community Health Workers (CHW). The certified CHWs, which are also found in other communities such as the Hmong and Somali, are trained to function as cultural bridges to the complex healthcare and government systems patients encounter.  Several Deaf CHWs have made themselves available to interpreters to discuss difficult cases, complex medical treatments and linguistic choices as they pertain to healthcare.

Another ally is the Association of Medical Professionals with Hearing Loss (AMPHL).  This past spring the AMPHL conference made a special effort to host a professional development track for sign language interpreters.  I was able to attend and found Deaf medical professionals excited and eager to work with me as an interpreter specializing in healthcare.

Supporting Quality Care

The demand for skilled healthcare interpreters is growing.  Those of us working regularly as healthcare interpreters are keenly aware, despite the lack of in-depth documentation in the field, of the depth of knowledge and skills required to do this work well.

As mentioned, my colleagues are continuing to develop themselves and build their specialization as healthcare interpreters.  As a field, healthcare interpreting should continue along the path toward specialization.  We should even consider further defining specialization in medical healthcare, mental healthcare, and addiction and recovery.

More Work Ahead

Yet, unlike legal and educational interpreting, there is no certification or credential for healthcare interpreting among sign language interpreters. I have introduced a motion for the 2013 RID conference next month requesting that RID investigate the need for a specialty certificate in healthcare interpreting.  This effort will only help to advance the important conversations we need about how we build interpreting practices in healthcare that are reflective and based on the delivery of quality care and practice.

For example, there has been a dramatic increase in healthcare as an area of specialized practice for spoken language interpreting.  In the past few years, two national organizations for the medical certification of spoken language interpreters have emerged.  Texas has developed such an interest in this certification that the state is currently working on a statewide medical certification for all interpreting language pairs—signed and spoken.  Yet, as an organization, RID has not yet made this commitment.  A small step has begun with the creation of the first members section for interpreters in healthcare, but as a field we are still struggling to focus on the work sign language interpreters do in healthcare and on providing the support, research, and training this important work requires.

Specialized Practice

In healthcare settings, we are often the only professionals who have not completed a standardized, accredited program recognized by the healthcare field.  As we continue to develop and to take our place as greater and active members of the healthcare team, we will need to consider what our model of practice might look like.  What behaviors must we demonstrate that indicate to the nurses, technicians and doctors that we are their colleagues, not friends or the patient’s family members? As professional colleagues, what are our obligations to these medical team members? How are we focusing on supporting the best health outcomes for the patient?

Systematically discussing questions like those above are only part of the bigger picture of developing standards of practice and quality care.  I believe the time has come to build a specialized practice of interpreters in healthcare.  We need to advocate that healthcare interpreters, Deaf or hearing, should have the education and supervised work experience to support full access to effective communication in healthcare settings for Deaf and DeafBlind people.  Communication is an important part of the doctor – patient relationship (Frey, 2012), when needed sign language interpreters should be an important part too.

 

References:

Cokely, D., & Winston, B. (2010). Interpreter practitioner needs assessment, trend analysis final report.

Frey, J., (2010, March). Relationships count for doctors and patients alike. Annals of Family, 8(2), 98–99.

National Interpreter Education Center. (2013). Interpreter practitioner, national needs assessment 2012, final report. 

Teitelbaum, J., Cartwright-Smith, L., & Rosenbaum, S. (2012). Translating rights into access: Language access and the affordable care act.  American Journal of Law & Medicine 348.

Wilson-Stronks, A., Lee, K. K., Cordero, C. L., Kopp, A. L., & Galvez, E. (2008). One size does not fit all: Meeting the health care needs of diverse populations. Oakbrook Terrace, IL: The Joint Commission.


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33 Comments on "Improving Healthcare: Specialization for Sign Language Interpreters"

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Member
Lori Whynot
Thanks for that informative article, Richard. Besides being a HC interpreter and trainer, I have begin running a case supervision/reflective practice group here in Australia (where I’m doing my PhD right now). A few of us have been through training to do this needed supportive reflective work alongside colleagues. It’s great you elaborate on the need for this in our profession. I believe it is professionally imperative that we practitioners begin to incorporate some form of structured reflective practice to improve our effectiveness. I also think the need for a specialty certificate in health care is a timely aim. It… Read more »
Member
Richard Laurion
Lori, Thank you. I’m happy the article resonates with you. Could you say more about the supervision work you are doing in Australia? I believe that observation/supervision is something we need to incorporate more widely. You mention the training you received, was that in Australia or when you were in the U.S.? I would like to see us find ways to promote an observation/supervision structure for ushering interpreters into this work from within the healthcare system Please consider submitting your own article to Street Leverage on the work you are doing. I look forward to your return to the U.S.… Read more »
Member
Richard, Great article, thank you for sharing! I believe strongly in the need for specilization in the interpreting field, whether that be healthcare, mental health, legal, etc.. It is no different than what lawyers, doctors, and mental health workers do themselves. I don’t think there are many doctors out there that work in all specialties, they usually pick an area of importance to them and specialize to ensure they are providing the best services possible with the greatest expertise. I would love to see the interpreting field move in a similar direction to ensure that the Deaf are getting the… Read more »
Member
Richard Laurion
Elijah, Thank you. I have been clear; I feel movement toward a healthcare certification is needed. I also believe the Core Competencies identified in the article above provide a good starting place for defining the knowledge and skills this certification might demonstrate. I am less certain which specific disciplines – medical health, mental health, addition and recovery or other – might be included. The motion offered for consideration at RID is asking the association to investigate the need for a certification or certifications. If not already, you and Lori might want to consider registering on the Interpreters in Healthcare RID… Read more »
Member
Austin Kocher

This was a very professional, high-quality post. Thanks, Richard.

Member
Richard Laurion

Austin,

I appreciate the compliment.

Thank you,

Richard

Member
Richard, Great topic! Wonderful that healthcare interpreting is gaining traction toward more resources for greater competencies! I like the idea of a healthcare specialty cert with one concern which I would like you to address here: many hospitals are replacing in house interpreters (staff/CEs/agency interpreters) with ONLY VRI. This seems to be the trend in spite of specific recommendations in lawsuits, Obamacare, and the joint health commission concerning the limitations of VRI in a hospital setting for some patients. My specific question is how would VRI and VRS rout a call in a call center specifically to an interpreter with… Read more »
Member
Richard Laurion
Meg: I would appreciate it if you could say more about your experience of staff interpreters being replaced by Video Remote Interpreting (VRI) only. As I indicated in the article, my experience has been a growth in staff interpreters, in fact growth across all areas. While I did not mention it in the article, I have also seen an increase in the use of VRI and freelance/community interpreters. As facilities have added staff interpreters, they often identify more areas where interpreting is needed. Much of this growth has been sustained through consumer and/or facility satisfaction with results. I think the… Read more »
Member
Rebecca Rosenthal
If I could vote(not a at the RID conference I would support this concept 100%. I used to live in an area with a hospital that hired staff interpreters. While it is great we had interpreters 24/7 on staff, it could be frustrating for various reasons. the coordinator is a relic, set in the old ways of interpreting practice, also s/he didn’t have the training in medical interpreting (i realize its not fair to say this but come on we live in an tech savvy environment that changes/improves every six weeks)! Secondly the interpreters hired for this hospital often had… Read more »
Member
Richard Laurion

Rebecca:

Thank you for the vote of confidence.

Richard

Member
Lindsey Antle

Thank you, Richard, for your always-spot on comments. Health care interpreting has been my passion for many years and I am pleased that the credentialing discussion has gained some public traction. I’m in!

Member
Richard Laurion

Thank you.

Member
Denise Falzone
I am not an Interpreter, but I am the person scheduling the Interpreter and obtaining contracts. I am familiar with medical terminology because I have a Veterinary Technician degree. I agree with certification for medical Interpreting; for accurate Interpreting is key to making a correct diagnosis. One of the facts that many medical clinics do not realize is that an Interpreter who is knowledgable in the medical field can get a Deaf person through the appointment quicker, hence in the medicaid/medicare world (unfortunately)time is money. Some of the small clinics, however, are struggling finacially with the fact that medicaid only… Read more »
Member
Richard Laurion
Denise: Welcome to the conversation. I appreciate your efforts to better understand interpreting and the collaborative role you have in our work. It helps to have multiple perspectives on any issue, so thank you for adding your thoughts. Somehow the question of whether to provide an interpreter or not for the healthcare facility often boils down to a financial discussion. You bring up an important competence interpreters also need to develop and that is the ability to negotiate with decision-makers in the system. Being able to identify and provide a persuasive argument for how our services help the provider save… Read more »
Member
I agree 100%! There needs to be a certification for medical interpreters. So many times I hear “they needed an interpreter last minute and I did it” This coming from new interpreters that barley have experience much less in a medical setting. I just went with a deaf friend to the ER as a friend not interpreter and its over welling all the vocabulary you must have and sometimes there is not time to stop and explain what a procedure is to the interpreter. Would you want a student Dr with minimal training or a person that wants to become… Read more »
Member
Richard Laurion

Michele,

Thank you for sharing the additional illustrations. It can help to compare what we might expect of ourselves with what we might expect from others in the same scenario.

Again, thank you,

Richard

Member
Interesting article but disagree with the recommended solution. Additional training, certifications…etc etc is not the answer and will only place more burden on the interpreters themselves. Instead, why not hold the agencies that provide these interpreters accountable? If the interpreters are not doing their job then find another agency that is competent in providing these interpreters. Interpreters are not doctors. We are language/culture experts. I think there are plenty of acronyms besides the names of all our interpreters and they still can be deficient, unethical and lacking in talent. If there needs to be more specialized certifications then why did… Read more »
Member
Richard Laurion
Josh, I applaud you for offering a counter perspective and I respect your concern for interpreters developing ourselves out of the industry. However, I find myself disagreeing with some of the conclusions you have drawn. Yes, agencies should be held accountable for the interpreters they place in assignments. However, interpreters need to be even more accountable for their work and training needs. It is ultimately the interpreters’ burden to be competent and to demonstrate that competence in the work they accept. You suggest that interpreters are language/culture experts. However, this expertise is not all inclusive. We certify interpreters as generalists… Read more »
Member
Shelly Hansen
Hi Josh and Mr. Laurion~ Quick response: I love the idea of having specific training and a certification in medical interpreting. It is a complex subject and deserves advanced training in the same way the SC:L gives an entry level interpreter training and a credential for working in legal settings. It would be an indication of focused study, training and preparation to work with people in a very critical part of their lives: their health care. I don’t care if there are less jobs out there in 5 or 10 years due to CIs or other technology. I am in… Read more »
Member
Richard Laurion

Shelly,

I hope you and the multiple voices here – both sides of the proposal – will make your comments during the conference business meeting. If you will not be attending the Indianapolis event, send your thoughts to the RID Secretary (secretary@rid.org), so they may be recorded.

I’ve also mentioned several parallel discussions are continuing at the Interpreters in Healthcare RID Member Section’s Google Group [https://groups.google.com/forum/#!forum/terpsinhealthcare ] and their Facebook page [https://www.facebook.com/groups/TerpsinHealthCare/]. If you have not registered on either site, please consider doing so today.

Thank you for your comments.

Richard

Member
David Stuckless
While a deaf person at work can provide input into the selection of interpreters, typically in the medical environment, the deaf person has to accept what (VRI) or whomever (interpreter/agency) shows up. And what if this is a moment of crisis? Should we leave the hospitals to the mercy of the lowest bidder? Relying on an interpreter’s own self awareness as to what skills are required continues to lead to many compromises in communication, in medicine and elsewhere. Many interpreters have nothing but personal experience and cursory training before entering the health care field. Any new training, testing and certification… Read more »
Member
Richard Laurion
David, You raise excellent points for our consideration. A valued aspect of interpreter services has been the right of the consumer to choose who they might work with. When provided, this allows the Deaf individual to be an important part of the decision-making process. As is suggested in the ADA, it becomes the Deaf person who decides if the interpreter is qualified for the situation or not. Due to the last-minute nature of some healthcare visits, that consumer choice may not be possible. How might we build this into the system? Is it an automatic assumption that if we use… Read more »
Member
Richard Thanks for your reply! I don’t want to mention specific situations but working in 2 states and DC I will say that despite lawsuits etc, some hospitals are still devolving as far as deaf patient’s rights and right of choice, while some are (thankfully) evolving. I see this with agencies as well. David brings up an excellent point about the advent of VRI and deaf consumer choice in medical situations. Even without the VRI component, it has become harder to honor client preference in health care settings for a variety of reasons; add to that the remote component, the… Read more »
Member
Ellen C Hayes

Meg,

Thank you…perfectly worded…whole heartedly supported! From one who spends 95% of her time interpreting in the medical arena…24/7. Thank you!

Member
Kevin Lowery
Approximately two years ago, RID decided there should be a medical certification. They gave it to NAD to create the parameters of a test, study materials, etc. NAD subcontracted the entire thing to an outside agency and it has never been heard of again. If this is RID’s idea of being responsive to the needs of the Deaf and hearing communities–as well as supporting the interpreting community–then they need to reconsider their timeline. Many other setting such as Performing Arts and other special certifications such as Mental Health are in desperate need of targeted instruction, testing and professional development. This… Read more »
Member
Richard Laurion
Kevin, You may need to provide a bit more direction to the actions you describe above. I have not heard of the activity you describe. Was this action taken by the Board? I’ve gone back over the last few conferences and found Motion F from 2011 which referred to specialty certifications in a general sense. That motion was withdrawn and the members did not have a chance to debate the idea. If you are referring to another motion or board decision, please direct all of us to the right spot. I hear some frustration in your post and I certainly… Read more »
Member
Kevin Lowery

Richard,
It was expressed to RID members that when this new system of certification went into place (without the Advanced and Master levels) that RID would focus on creating special certifications. Except for that 2011 Motion F (thanks for clarifying that, btw) we haven’t heard anything. Yes, I will write to RID since I am unable to attend the convention. Also, Richard, not having a chance to vote on something since 2011 is not responsive enough for our industry to keep pace with the changing world of interpreting.

Member
Donovan Smith
Richard, Thank you for bringing this up. I am recent graduate from an ITP. (This is my second career and will be starting soon as a post-secondary interpreter). I am a Coda myself and I see the importance of having a good head knowledge of WHAT you are interpreting. When starting out on my journey of becoming an interpreter I was kind of surprised that there was not a certification level for medical interpreting. Just about any free-lance interpreter can show up at a hospital or clinic and walk into a situation that could possibly be life threatening. To think… Read more »
Member
Richard Laurion

Donovan:

Thank you.

Best of luck in launching your career and I hope you will consider healthcare as an area of focus for your future work.

Richard

Member

I would like to do a workshop in my area on Medical Interpreting. This hasn’t been done where I from to my knowledge in a long time. Do you know of someone who could lead the workshop or be interested in providing training for a one day (I know that’s not enough time) or even in a series? Or resources? Please let me know. Thanks!

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