How to Work with Interpreters and Translators

Henriette_Langdon  Langdon_WWIT  Terry_Saenz

By Henriette W. Langdon, Ed.D., FCCC-SLP and Terry I. Saenz, Ph.D., CCC-SLP, authors of Working with Interpreters and Translators: A Guide for Speech-Language Pathologists and Audiologists

Our world is increasingly heterogeneous. English is no longer the only language spoken in the United States, England, or Australia. French is not the only main language spoken in France and neither is German the only language spoken in Germany. Immigration caused by political and economical changes has dispersed many people to other countries in the world in search of better opportunities. Consequently, communication between these individuals and residents of the different countries is often disrupted due to the lack of a common language. This challenge has existed throughout humankind, but it seems that it has increased in the last century or so. There have always been people who knew two languages that needed bridging, but now this urgency is more pronounced. The need for professionally trained interpreters was first noted following the end of WWI when the Unites States was first involved in world peace talks alongside many nations with representatives who all spoke a variety of languages. This historical event eventually led the League of Nations to the foundation of the École d’Intèrpretes in Geneva, Switzerland in 1924. Since that time, many other schools that train bilingual interpreters to participate in international conferences have been established. The AIIC [Association Internationale des Interprètes de Conférence (International Association of Conference Interpreters)] Interpreting Schools directory lists a total of 87 schools worldwide: http://aiic.net/directories/schools/georegions. The reader can gather information on which specific language pairs are emphasized in the various training schools; for example, Arabic-English; French-Spanish, Chinese-English, and so forth. Thus, interpreting for international conferences is a well-established profession today, offering specific training and certificates. However, interpreting is necessary not only for international conferences, but also to assist in bridging the communication in everyday contexts such as medical or health, judicial, educational (schools) and the community at large. Training and certification in areas such as medical and judicial have slowly emerged and are available to those who need them in various states throughout the United States. Legislation has been the primary force in the establishment of certificates in the areas of medical and legal interpreting. However, training in other areas where interpreting is needed such as education, and our professions, speech pathology and audiology, are notoriously lacking. There are some situations where medical interpreters can assist speech-language pathologists (SLPs) and audiologists in a hospital or rehabilitation center, but even those interpreters may not have the specific terminology and practice or procedures to work effectively with our professionals. Working with Interpreters and Translators: A Guide for Speech-Language Pathologists and Audiologists is a second revised and expanded edition on this topic that provides SLPs, audiologists, and interpreters who collaborate with them some concrete tools and strategies on how best to conduct interviews, conferences, and assessments when the client and/or family does not speak English fluently.  The proposed process is based on information gathered from other interpreting professions. The research, and some personal interviews with audiologists in particular that were conducted to assemble this information, indicate that the process is conducted haphazardly at best.  The literature available on the collaboration between SLPs and interpreters indicates that both parties are not secure about procedure and must learn how to work together by trial and error. Often the SLP does not trust the interpreter and the interpreter does not follow suggested procedures, such as failing to interpret all that is being said, conducting a side conversation with a parent during a meeting, and giving the child unnecessary cuing during testing (if tests are available in the child’s language, which is primarily Spanish). Literature on working effectively with audiologists is almost nonexistent; therefore, the first author resorted to several personal interviews with audiologists, a specialist of the deaf and hard of hearing, and professors of audiology throughout the country. Often individuals who perform the duties and responsibilities of the interpreter and who are hired to do this job are not fully bilingual; they may speak the two languages, but may not be able to read or write the language they are using to interpret. These interpreters are often not respected, are not treated as professionals, and their pay is very low.

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Effective Communication: A New Health Care Obligation

Beukelman Effective Communication Image

By: Sarah W. Blackstone, David R. Beukelman, and Kathryn M. Yorkston
Editors of the new Patient-Provider Communication: Roles for Speech-Language Pathologists and Other Health Care Professionals

Prior to his accident, Frank was a 26-year-old energetic, physically active young adult with a wide range of interests and a full social life. A C3–C4 cervical spine injury left him unable to move his limbs. When medically stabilized, he was transferred to the surgical intensive care unit, where he was ventilator dependent and in halo traction. He was unable to speak and his only intentional gesture was a gaze shift. The hospital communication team helped Frank establish a reliable yes/no response (looking up to indicate “yes” and down for “no”). They encouraged his nurses and family to offer other choices as well (“maybe” or “later” or “I don’t know”). A speech-language pathologist showed him a speech-generating device (SGD), but when initially asked if he wanted to use it to “talk,” he responded by looking down, “No.” Later that same day, the team demonstrated the SGD again, showing him how he could use it to control the TV and a fan. When asked if he would be willing to give it a try, he replied, “Yes!” by looking up. Within 24 hours, Frank was using a template on the SGD to call a nurse, ask for medication, control a fan, and turn the TV off and on, all with a simple serial scan method and a switch. Over time, he became an active participant in his recovery process, asking doctors questions and participating in decisions about his treatment plan.

Effective communication between patients and providers is a core component of patient-centered and value-based health care. According to the Joint Commission (2010, p.1), effective patient provider communication is the successful joint establishment of meaning in which patients and health care providers exchange information, enabling patients to participate actively in their care from admission through discharge, and ensuring that the responsibilities of both patients and providers are understood. To be truly effective, communication requires a two-way process (expressive and receptive) in which messages are negotiated until the information is correctly understood by both parties.

The medical encounters that occur across the continuum of health care are usually time constrained and many are stressful, high-stake interactions. When communication breakdowns occur, the impacts can be devastating for patients, family members, providers, and the health care system. Research shows that communication difficulties are among the major causes of sentinel events and can negatively affect patient outcomes, safety, and satisfaction, as well as result in increased readmission rates, length of stay, and additional health care costs. Because of the diversity of patients and families served in our health care systems, successful communication can be very difficult to achieve. In fact, many patients present with multiple communication vulnerabilities.

At age 4 years, 6 months, Guillermo was in the ICU, intubated and awake following a series of surgeries for tracheoesophageal reconstruction. Guillermo and his family were from Honduras and spoke Spanish only. Guillermo was most relaxed when his mother or eldest brother were sitting next to his bed and rubbing his arm. Although hospital policy supported his family remaining at bedside throughout the day and night, there were moments when they needed to step away for personal care, to attend team meetings along with a translator, or for other reasons. The speech-language pathologist provided Guillermo with a simple voice output aid (Ablenet Little Mack) with messages that included, “Where is my family,” recorded in both Spanish and English, so hospital staff could understand him. The speech-language pathologists also made a 20-target Go Talk+ device (Attainment Company) available to him. It featured 15 target photos of family members with messages such as, “I want mom,” “You’re my best friend, Frederico,” “I love you,” and “Hold my hand,” as well as some medical messages. All messages were recorded in both languages.

We define “communication vulnerability” as the diminished capacity of an individual to speak, hear, understand, read, remember, or write due to factors that are inherent to the individual (e.g., disabilities related to receptive and expressive language skills, hearing, vision, speech, cognition, and memory, as well as language spoken, lifestyle, belief system, and limited health literacy), or related to the context or situation (e.g., a noisy environment, being intubated in an intensive care unit after surgery, suffering injury while traveling in a foreign country, having cultural practices, lifestyles, or religious beliefs that are not understood or accepted by providers).

Eleven-year-old Joshua had a bone marrow transplant. He was acutely aware of his suppressed immune system and created and used several communication tools during the time he required the use of a Bi-PAP noninvasive ventilator. Using a simple voice output communication tool, Joshua insisted on having the following message available at all times: “If anything falls on the floor, use the Sani-wipe to clean it before you let it touch me. Also, if your gloves touch the floor when you pick it up, change your gloves before coming near me.”

In the book, Patient-Provider Communication: Roles for Speech-Language Pathologists and Other Health Care Professions, we describe how health care facilities and the providers who work within them can begin to assume a more active role in supporting patients who are communication vulnerable. Speech-language pathologists, nurses, administrators, and physicians are key to improving the “culture of communication” within their facilities, spearheading interprofessional practices that benefit all patients and ultimately providers and the facility’s bottom line. Currently, the role of communication intermediary is assumed by a few providers or family members with a personal commitment; although a rising number of health care organizations are beginning to specify policies and role assignments regarding the coordination of communication support services, communication facilitation for all patients with communication difficulties (not just those who are deaf or have second language issues), or a legal or medical intermediary designated to ensure that communication vulnerable patients accurately participate in legal and medical decisions.

Examples of promising practices and strategies across health care settings are highlighted in individual chapters that focus on doctor visits, emergency services, Intensive and acute care settings for children and adults, inpatient and outpatient rehabilitation, long-term residential care, and end-of-life care. In this book, we have invited authors who have considerable expertise in patient provider communication services across the range of health care settings to share information about the policies, intervention strategies, communication materials, and technologies that are being implemented within their medical settings to support the needs of communication vulnerable patients.

The wife of a person with ALS described his end-of-life experience: He was having a great deal of difficulty breathing and simply could not get comfortable in his hospital bed or wheelchair. We decided to go with in-hospital hospice since his pain management was not well controlled. In hospice, he regularly used his (eye gaze-accessible) SGD to tell us what he did and did not want. I am so grateful that he was able to use it extensively during the last few days of his life. I do not know what we would have done without it.

The authors recognize that there continues to be a considerable gap between clinical research evidence, what is mandated by health care policy, and what is experienced every day by patients, their families, and providers during medical encounters because of the ways in which many health care organizations currently deliver care. In other words, we recognize that implementation, or the process of putting effective patient-provider communication policies into practice, continues to be a challenge within many health care organizations; however, in the final chapter of Patient-Provider Communication we discuss a number of implementation strategies.

References
The Joint Commission. (2010). Advancing effective communication, cultural competence, and patient and family centered care: A roadmap for hospitals. Oakbrook Terrace, IL: Author.

About the Authors
Sarah W. Blackstone, PhD, CCC-SLP, is president of Augmentative Communication, Inc. She has authored multiple texts in the augmentative and alternative communication field as well as articles in Augmentative Communication News and other publications. David R. Beukelman, PhD, CCC-SLP, is the Barkley Professor of Communication Disorders at the University of Nebraska-Lincoln. He has served as director of research and education for the Communication Disorders Division, Munroe-Meyer Institute for Genetics and Rehabilitation at the University of Nebraska Medical Center. Kathryn M. Yorkston, PhD, BC-ANCDS, is a professor of rehabilitation medicine and head of the speech pathology division within the Department of Rehabilitation Medicine at the University of Washington Medical Center.

Are Your Services Educationally Relevant?

Jean BlosserSchool Programs in Speech-Language Pathology 5th Edition

Jean L. Blosser, EdD, CCC-SLP
President, Creative Strategies for Special Education
Author, School Programs in Speech-Language Pathology: Organization and Service Delivery, Fifth Edition, Plural Publishing, 2012

Educational Relevance—What an Important Concept!
Does a child’s disability impact his or her performance in the classroom? If yes, would services such as speech-language intervention, occupational therapy, or physical therapy make a difference? Should those services be intensive, provided face-to-face or via technology, or integrated into the classroom? The primary question is, if therapy services are offered, will the intervention provided make a difference in the student’s classroom performance, ability to access the curriculum, and/or ability to reach his or her potential?

These are huge questions that administrators, educators, clinicians, and parents ponder every day. When school teams evaluate a student, they seek to determine how the disability may be interfering with the student’s learning. Key educational areas that may be affected are academic, social-emotional, and vocational performance. If everyone agrees there is an adverse effect on educational performance, the student’s eligibility for services is confirmed.

How Do We Guarantee Educational Relevance? Continue reading

Augmentative and Alternative Communication: From Novice to Expert Clinician

By John McCarthy, PhD, CCC-SLP and Aimee Dietz, PhD, CCC-SLP

Augmentative and Alternative Communication

Augmentative and Alternative Communication by John McCarthy and Aimee Dietz

Understanding the personal story of an individual who uses augmentative and alternative communication (AAC) can have a positive impact on the attitudes of people without disabilities toward that individual (McCarthy, Donofrio-Horwitz, & Smucker, 2010). Almost any AAC specialist has story after story of moments when they have helped reveal the true abilities of an individual through AAC:

• The eight-year-old boy with cerebral palsy who everyone assumed had below average intellectual ability and presymbolic language skills, was in fact bilingual.
• The forty-year-old woman with bulbar onset amyotrophic lateral sclerosis who cannot dress or feed herself, but still manages her finances, parents her children, and makes end-of-life decisions.
• The eighteen-year-old girl with autism spectrum disorder whose potential to contribute to society was doubted, yet planned for employment after high school and managed a new mobile device-based communication system.
• The fifty-two-year-old man with stroke-induced aphasia who medical staff assumed was “incompetent”; however, still made informed decisions about medical care and enjoyed friendly banter on the golf course with his adult sons.  Continue reading

2014 Awards and Honors

We are thrilled to announce the winners of the 2014 Plural Publishing Research Awards given in honor of the late Dr. Sadanand Singh. These two scholarships are awarded by the Council of Academic Programs in Communication Sciences and Disorders and honorees and their faculty sponsors are acknowledged at the annual CAPCSD meeting, taking place this year in Orlando, FL, April 10-12. Congratulations to Doreen Hansmann, the master’s level winner and to Meg Simione, the doctoral level winner.

Doreen Hansmann, Master’s level Research Award recipient

Doreen Hansmann, Master’s level Research Award recipient

Meg Simione, Doctoral level Research Award recipient

Meg Simione, Doctoral level Research Award recipient

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Aphasia Awareness Month

June is National Aphasia Awareness Month! Check out our new aphasia product called Simple Counseling.  It’s not a book, but a self-contained website on CD-ROM intended to support university instructors who seek to focus students on principles and methods of counseling pertinent to adults who have aphasia.

Asia Pacific Journal of Speech, Language and Hearing

The June issue of the Asia Pacific Journal of Speech, Language and Hearing is available online! For your research needs, you can order individual articles or the complete issue. Brought to you by international allied health experts, the June issue brings together six articles containing peer-reviewed experimental and clinical research papers, reviews, clinical notes, comments and critiques on all aspects of normal or disordered speech, language and hearing research. Order online now!

Show Your Support!

Image from http://www.stutterisa.org/ISAD.html

Celebrate International Stuttering Awareness Day with Plural! ISAD started in 1998 and falls on October 22nd. ISAD seeks to bridge the gap between Speech-language professionals and consumers to learn from each other how and work together to support, educate and raise the general awareness on the impact of stuttering.

Plural is working hard by publishing these great works:

http://www.pluralpublishing.com/publication_hhst.htm

http://www.pluralpublishing.com/publication_stuttering.htm

http://www.pluralpublishing.com/publication_tpfs.htm

http://www.pluralpublishing.com/publication_sm.htm

http://www.pluralpublishing.com/publication_kiddycat.htm

Interested in being a smooth talker?

Smooth Talking: A Curriculum for School-Age Children Who Stutter

By Nola Radford, PhD.

This comprehensive curriculum provides Speech-Language Pathologists with every tool necessary to treat stuttering in children ages 7-14. Dr. Radford has worked with over 40 children from all different backgrounds and races in developing this curriculum, which includes: a clinician’s workbook, a student workbook filled with many exciting and different activities, an audio CD, and a DVD to help explain the curriculum. This is a must-have for any Speech-Language Pathologist!

Get it Here!

Or get a pack of the student workbooks here.

There’s more too! Check out the Smooth Talking Boardgames for a supplement to the workbook that is sure to add hours of fun and learning!

Did you HEAR about it?

Another New Release this week!

Human Auditory Evoked Potentials, By Terence Picton, MD, PhD, FRSC

This new book explores the brain’s response and relationship to sounds, and, how we can use these responses to assess hearing. These findings have many implications clinically- identifying hearing impairments in newborn infants, detecting tumors on the auditory nerve, the diagnosis of multiple sclerosis, as well as many others. They are also used to investigate how the brain is able to hear, giving insight into social situations as well as why we have difficulty hearing when we grow old. Written with clarity and crispness, in a style that is meaningful, Picton makes this book a joy for anyone to read!

Check it out Here!