How to Work Effectively With Interpreters

1. How to Work Effectively With Interpreters

2. Workshop Goal To improve communication with patients with Limited English Proficiency by learning techniques for working with interpreters.

3. 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.

4. Hold Your BreathView clip at http://www.youtube.com/watch?v=jyQvMx18iXw 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.

5. 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.

6. 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 follow-up appointment (Sarver and Baker 2000) • Have more tests done creating a higher overall cost (Hampers and McNulty 2002)

7. 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)

8. 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)

9. 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.

10. Key ethical principles for interpreters • Accuracy • Confidentiality • Impartiality • Acting in a professional and ethical manner National Council on Interpreting in Health Care, 2004 www.ncihc.org

11. 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.

12. 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.

13. 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.

14. 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.

15. After the appointment • Debrief with the interpreter, if necessary, about the communication process.

16. Video Vignette 1 • Click below link to watch on YouTube (3:18 minutes) • http://www.youtube.com/watch?v=KAl2u69o7Y8 • 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?

17. Final vignette • How might you implement these strategies in your work environment? • What challenges might you face implementing these strategies?

18. Post Test Question 1 Which of the questions below would encourage direct communication with your patient? • 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?

19. 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 PROVIDER

20. 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.

21. Post Test Question 4 It is appropriate to ask the interpreter’s opinion about cultural issues: • 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.

22. Post Test Question 5 Name two possible consequences when patients with LEP are not provided a qualified interpreter.

23. Pap smear Inhaler CAT scan Angiogram Preeclampsia Autism PTSD Food support Retrospective eligibility How might these concepts be explained in layman’s terms?

24. Post Test Question 1 Which of the questions below would encourage direct communication with your patient? • 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?

25. Post Test Question 1 b) Are you still having stomach pains?

26. 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 PROVIDER

27. 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.

28. Post Test Question 3 a) Ask the patient to repeat the information back to you.

29. Post Test Question 4 It is most appropriate to ask the interpreter’s opinion about cultural issues: • 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.

30. Post Test Question 4 c) When you are unable to get an explanation from the patient him/herself.

31. Post Test Question 5 Name two possible consequences when patients with LEP are not provided a qualified interpreter.

32. 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)

33. Please feel free to ask the facilitator any questions you have. Thanks for coming! Q + A