● Seating should promote direct eye contact between caregiver and patient throughout the encounter and will reduce the likelihood of diverting attention from the patient. Equilateral triangle seating or having the interpreter sit just behind and to the side of the patient are both acceptable positions. ● The interpreter should be oriented to the role expected by the therapist, if unfamiliar to the therapist. ● The therapist should explain the role of the interpreter to the client or patient and ask whether the patient is comfortable with this. ● The therapist should request word-for-word interpretation from the interpreter without paraphrasing. ● The therapist should use short sentences in “digestible chunks,” allowing for interpreter understanding and accurate interpretation and allowing for repetition for clarification. ● The therapist should listen actively to the client or patient and the interpreter and summarize what is said. ● The therapist can ask the client or patient to “back interpret” or summarize what he said to verify the accuracy of the interpretation and the patient’s understanding. ● Visual aids and written handouts should be used where available, appropriate to the client or patient’s literacy level. ● The interpreter should accompany the client or patient to schedule follow-up appointments. Despite using the best of communication styles, an open- ended question such as, “What can I do for you today” to begin the interview is not effective in eliciting a full history and an adherence to a treatment plan, negatively impacting the outcome of the client’s care. The therapist has now encountered a secondary communication problem in addition to not working effectively with the interpreter. Interpreters in some settings may have their own viewpoints about how providers should communicate with a client or patient through them. These views should be taken into consideration when interacting with an interpreter. Examples of things that interpreters should not be asked to do without the provider present, includes: ● Keeping the LEP client or patient company. ● Explaining procedures without the provider being present. ● Taking a medical history. ● Signing or explaining a consent form without full explanation. videoconferencing; written translated materials should be made available to LEP patients. ● Recommendations for working effectively with an interpreter include early role setting and orientation of the interpreter, communicating with the client or patient to establish expectations, and the use of appropriate eye contact, body language, sentence structure, construction, and seating arrangement to respect the client or patient’s needs and culture. American Heritage Science Dictionary, Fifth Ed. Houghton Mifflin Company. (2015). Retrieved June 2, 2016 from https://ahdictionary.com/word/search. html?q=Race&submit.x=28&submit.y=24(2015) American Massage Therapist Association. (2010). Code of Conduct . Retrieved June 2, 2016 from http://www.amtamassage.org/About-AMTA/Core-Documents/Code-of- Ethics.html. Association of American Medical Colleges. (2015). TAACT . Retrieved June 2, 2016 from http://www.aamc.org/meded/tacct/start.htm.
In addition to the observance of CLAS guidelines by the health and wellness industry, training for health providers to work effectively with interpreters has been shown to increase the use of professional interpreters and health provider satisfaction with the care they provide. Effective interaction with interpreters is a standalone and a distinct skill domain in the AAMCs Tool for Assessing Cultural Competency Training Association of American Medical Colleges (2016). The following stated learning objectives are offered for health providers, and can also apply to massage therapists: ● Describe functions of an interpreter. ● List effective ways of working with an interpreter. ● Identify and collaborate with an interpreter. Various curricula have been described for teaching health professionals to work with interpreters - including an online case-based interactive module NYU School of Medicine (2016). When working with interpreters, most guidelines address the following issues with similarly suggested behaviors for providers: ● A trained interpreter should always be used when available. ● Avoid untrained interpreters (such as relatives or untrained staff) who are likely to compromise the accuracy of terminology. ● Use of relatives, especially children of patients, creates problems with social roles, sensitive issues, and compromises the ethics of confidentiality. Case study A 60-year-old Hispanic woman was to be interviewed by a female therapist. A male interpreter was sitting next to the client. The therapist, upon entering the room and sitting down opposite the client and interpreter, immediately asked the client through the interpreter “What can I do for you today?” The client is silent. The therapist then asks the interpreter “Why does she not speak?” The interpreter shrugs and asks in English how long the interview will take. Discussion In this scenario, the therapist failed to orient the interpreter to both his role and to her expectations of the encounter’s interpretation process. More importantly, the therapist failed to discuss and explain the interpreter’s role with the client, including asking the client’s permission to work with this interpreter. In this instance, the client has a personal problem in that she is uncomfortable discussing in front of a male interpreter. She has chosen to remain silent rather than reveal her reasons for the visit. The client would have preferred the option of a female interpreter. Section summary ● LEP encounters without adequate language interpretation risk lower client or patient satisfaction and result in poor health outcomes. ● Lack of knowledge of the impact of language access on health care, changing local community demographics, and logistic barriers contribute to underutilization of interpreters. ● Professional interpreter services can be provided face-to-face, in-person, by telephone, and through Accreditation Council for Graduate Medical Education (2016), Pursuing Excellence in Clinical Learning Environments . Retrieved June 2, 2016 from http://www.acgme.org/ Portals/0/MilestonesGuidebook.pdf Akinbami, L. (2014). Community Benefit Report: Children’s National Health System . Retrieved June, 2, 2016 from http://communitybenefitreport.herokuapp.com/ American Academy of Family Physicians. (2016). Cultural Proficiency . Retrieved June 2, 2016 from http://www.aafp.org/patient-care/social-determinants-of-health/cultural- proficiency.html References
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