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A collection of resources identifying and supporting best practices for interpreting in healthcare settings.

The career lattice for moving from novice healthcare interpreter to intermediate to specialist

New Tool for Developing a Healthcare Interpreting Career

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Do you have an interest in healthcare interpreting?  Without a clear structure for determining competency to interpret in healthcare settings, it is not surprising that interpreters, educators, and students are often unclear on the path to work in this specialized area.

Healthcare Interpreting Career Lattice

The Healthcare Interpreting Career Lattice is a new resource from the CATIE Center and NCIEC designed to provide a framework for developing the knowledge and competencies needed for the healthcare setting.

The Healthcare Interpreting Career Lattice maps the phases of development after obtaining a BS/BA degree and certification, to working autonomously as an interpreter in healthcare settings. Interpreters can enter and exit this progression at various points, depending on their background, knowledge, competencies, career goals, and job requirements. Each stage offers recommendations for professional development, and includes links to resources.

The Lattice is useful for:

  • Attracting individuals to the specialty of healthcare interpreting.
  • Providing guidance for those seeking professional development in healthcare interpreting.
  • Offering interpreters at all levels of experience specific information about training, education, and experiences leading to greater expertise.
  • Assisting educators, academic advisors, students and potential students in outlining careers and the critical experiences individuals should acquire to enter and progress through careers in healthcare interpreting.
  • Informing individuals who may rely on interpreting services in healthcare about the general levels of experience, education and training of ASL-English interpreters.

Career lattices are common in many practice professions, such as nursing and physical therapy. They are designed to help people conceptualize professional development within a field. Because there are currently no national certifying or credentialing processes in place for ASL-English healthcare interpreters, the Healthcare Interpreting Career Lattice is a means for Deaf and hearing interpreters to better understand the progression toward competency in healthcare interpreting.

The Healthcare Interpreting Career Lattice relies on the individual interpreter to actively seek out and participate in specific activities and to document completion of the activities. In addition to the current resources included, observation and supervision, as well as mentoring are important components of the professional development of healthcare interpreters. The Lattice provides guidance while promoting individual accountability for one’s career development.

The Lattice is not meant to capture all the details related to specific training or educational activities for advancement in the field of healthcare interpreting, but rather to provide resources and guidelines for developing competency.

 

Click here to explore the interactive Healthcare Interpreting Career Lattice!

Be sure to check out the wealth of resources in the “additional preparation” boxes.

Please share this information with interpreters, educators, healthcare professionals, and others who may be interested.

U.S. Department of Justice ADA bulletin: Effective Communication

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The U.S. Department of Justice routinely publishes consumer information documents on the Americans with Disabilities Act.  The linked document here describes the multiple ways in which agencies and industries might better serve consumers who are Deaf, Hard of Hearing, DeafBlind or Visually-Impaired.

Download the DOJ Document

A list of the different domains - as spokes in a bicycle wheel

Domains & Competencies for Medical Interpreters

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HolisticWheelDomains and Competencies

Medical Interpreter: ASL/English

DOMAINS AND COMPETENCIES
October 9, 2008

Download PDF of Domains and Competencies

Overview

A Medical Interpreter: ASL/English is a credentialed professional with national certification, CDI or CSC or CI and CT or NIC Advanced or NIC Master (1), who facilitates communication between users of signed and spoken languages in health care settings throughout the life span. Qualifications include:

  • Bilingual fluency in English and ASL including the ability to produce and comprehend sociolinguistic variation.
  • Understanding of linguistic, social and cultural influences that impact health care interactions (e.g., specialized vocabulary, discourse styles, language register, dynamics of power and prestige between interlocutors, and triadic communication).
  • Adhering to the Registry of Interpreters for the Deaf and the National Association of the Deaf Code of Professional Conduct and familiarity with the NCIHC code of ethics.
  • Balancing the need for maintaining professional distance with empathy and flexibility.
  • Knowing the laws and policies related to health care settings (e.g., liability, ADA, state’s human rights laws, hospital policies).
  • Knowing the general physiological and psychological implications of health care.
  • Understanding of various health care approaches (e.g., Chinese medicine, ayurvedic, holistic, homeopathic, Western medicine, hospice).
  • Understanding underlying practices of various health care delivery systems and the role of self and others on the health care team (e.g., employing CDIs, Deaf Community Healthcare Workers [CHWs] and advocates when they can enhance the communication).
  • Sharing information and resources about communication through advocacy, leadership, education in health care settings.

All of the following credentials are offered by the national Registry of Interpreters for the Deaf in the United States: CDI-Certified Deaf Interpreter, CSC-Comprehensive Skills Certificate, CI-Certificate of Interpretation, CT-Certificate of Transliteration, NIC-National Interpreter Certification.

Domain 1.   Health Care Systems

  1. The interpreter demonstrates knowledge of the health care context including differences between public and private health care systems and hospitals, various venues where medical care is provided, common diagnoses and treatments, institutional hierarchy, and roles and responsibilities of health care personnel.
  2. The interpreter demonstrates knowledge of medical terms, procedures, and protocols of the health care system and specialized environments.
  3. The interpreter possesses bilingual competence with technical vocabulary pertaining to common medical procedures, diagnoses and treatment (e.g., medications, physical exams, MRIs, radiation).
  4. The interpreter discusses the role and function of the interpreter as part of the health care team in a professional manner.
  5. The interpreter applies knowledge of health care systems and the rights and needs of Deaf, deaf-blind and hard of hearing people to affect positive and systemic change (e.g., health care literacy).

Domain 2.   Multiculturalism and Diversity

  1. The interpreter exhibits behaviors and practices that demonstrate respect for patients and healthcare providers from diverse backgrounds and with diverse beliefs, striving to provide interpreting services that respect the cultures, values and norms of the consumers involved.  The interpreter demonstrates strategies for working with consumers for whom healthcare settings provoke increased anxiety.
  2. The interpreter provides information to health care professionals regarding the importance of creating a visually accessible environment for Deaf, deaf-blind and hard of hearing people (e.g. communication boards, use of lights, avoid responding through an auditory intercom when patient presses call button).
  3. The interpreter demonstrates strategies for working with Deaf people and health care professionals who have had prior negative experiences with access to health care (e.g., experiences of discrimination due to socioeconomic status or cultural beliefs).
  4. The interpreter assesses and accommodates varied levels of language competency, knowing when to call in a specialist such as a CDI or Deaf Community Health Worker (CHW).
  5. The interpreter demonstrates respect for consumers’ autonomy allowing consumers to make their own decisions.
  6. The interpreter maintains awareness of changes in the communities in which s/he works, such as an infusion of immigrants, and is able to interpret in medical settings effectively for patients and providers with varying cultural and religious needs.

Domain 3.   Self-Care

  1. The interpreter recognizes issues in the work environment that may create distress within oneself and employs strategies for dealing with feelings (e.g., vicarious trauma).
    • Mental, emotional, social and spiritual wellness (e.g., journaling, exercising, seeking support from a trusted confidante or professional counselor).
  2. The interpreter monitors personal health and avoids unnecessarily exposing vulnerable patients to germs or contagious illnesses (e.g., cold, flu, tuberculosis).
  3. The interpreter demonstrates awareness of personal safety practices in health care settings (e.g., stands behind a shield when x-rays are taken, wears a mask when a patient has an airborne disease, applies universal precautions).
  4. The interpreter demonstrates physical and emotional stamina necessary for interpreting in health care settings, including how and when to call in a team member (e.g., procedures that last several hours such as births or procedures with intense smells).

Domain 4.   Boundaries

  1. The interpreter declines medical interpreting assignments that are beyond his/her capability, be it emotional, physical, or level of language competence.
  2. The interpreter limits personal involvement with all parties during interpreting (e.g., not sharing or eliciting overly personal information in conversations with patients or health care providers).
  3. The interpreter separates one’s own personal values and beliefs from those of other parties (e.g., interprets all reproductive choices to Deaf patient regardless of own beliefs).
  4. The interpreter does not assume the right to make decisions for the patient and his/her treatment or healthcare plan and is aware of how the interpreter’s use of language can subtly change or influence decisions.
  5. The interpreter works as part of an extended interpreting team sharing important information, language approaches, etc. with other interpreters serving the same patient, allowing for continuity of service.
  6. The interpreter discloses or attempts to avoid potential conflicts of interest where professional boundaries may be compromised (e.g., does not interpret for a family member or close friends, may decline to interpret for a person’s performance appraisal at work if that person is a regular consumer in a health care setting).
  7. The interpreter promotes patient autonomy (e.g., does not offer patients a ride home, or offer to pick up patients’ prescriptions).
  8. The interpreter determines when it is appropriate to protect an individual from serious harm (e.g., intervenes on behalf of a patient with a life-threatening allergy, if the condition has been overlooked).
  9. The interpreter consults with professional colleagues on matters of importance and concern (e.g., other interpreters, members of the health care team), and suggests ways to overcome communication or language challenges using a Deaf Interpreter, social worker, Community Health Worker (CHW) or patient advocate
  10. The interpreter works as part of an interdisciplinary team to ensure effective communication.

Domain 5.   Preparation

  1. The interpreter demonstrates awareness of one’s own emotional filters, attitudes, and health care biases, beliefs and values.
  2. The interpreter obtains relevant information prior to the specific interpreting assignment and has the skills to sufficiently research the background on various procedures and treatments to allow effective visual representation of the procedures.
  3. The interpreter attempts to obtain appropriately relevant information prior to and during the specific interpreting assignment (e.g., reason for the appointment, reading brochures, studying charts on the walls).
  4. The interpreter possesses a readiness plan for working in various situations such as with refugees and immigrants, for example, who may not have acquired ASL or English (e.g., uses models and pictures, knows when/how to get a CDI or Deaf CHW).
  5. The interpreter maintains a sufficient amount of professional liability insurance.

Domain 6.   Ethical and Professional Decision Making

  1. The interpreter applies ethical principles in decision making, and understands the ramifications of decisions (e.g., when to accept or decline assignments).
  2. The interpreter demonstrates awareness of the impact of demographics on decision-making (e.g., Deaf people may be known very well to the interpreter in a small town).
  3. The interpreter demonstrates knowledge that the decision-making processes and the expectation to disclose and/or report certain information may be different between staff interpreters and freelance interpreters (e.g., staff interpreters may have more access to pertinent information and make different decisions than freelance interpreters).
  4. The interpreter has advanced decision-making skills and knows when ethical dilemmas need to be resolved in collaboration with the patient and healthcare provider in order to lead to the best outcome for patient treatment and recovery.
  5. The interpreter recognizes the need for patient privacy and exercises discretion about staying in the room or leaving (e.g., during medical procedures, private family conversations).

Domain 7.   Language and Interpreting

  1. The interpreter demonstrates ASL and English interpreting skills, linguistic competency, cultural knowledge and fluency in medical discourse in both English and ASL.
  2. The interpreter is able to interpret both consecutively and simultaneously, understanding the ramifications of each format and demonstrating the knowledge and skills to move effectively between these formats during a single appointment or procedure (e.g. considers factors such as acute care needs and the potential for disrupting a participant’s train of thought when deciding whether or not to use consecutive interpreting).
  3. The interpreter determines when an explanation of a specific interpreting process is required, and provides a rationale for its use (e.g. consecutive interpreting, simultaneous interpreting, or the use of a CDI).
  4. The interpreter adapts the interpretation for age, gender, and culture (e.g., immigrants).
  5. The interpreter adapts for individuals who are not proficient in ASL or English (e.g., uses a CDI when appropriate).
  6. The interpreter communicates assertively in interactions with patients and service providers, in order to render an effective interpretation (e.g., if the health care provider is ready to leave the room before the interpretation is completed, the interpreter may intervene and ask the provider to wait for a moment in case there are questions).
  7. The interpreter demonstrates skills in working as part of a team with CDIs and spoken language interpreters.
  8. The interpreter is able to describe how language barriers can compromise access to health care for Deaf patients and health care providers.
  9. The interpreter strives for accuracy when interpreting between all parties (e.g., knows when to seek clarification of the message).
  10. The interpreter demonstrates strategies for interpreting in settings when the Deaf individual cannot see the interpreter (e.g., x-ray, eye exam, informs the providers that the resulting silence during the event does not constitute agreement).
  11. The interpreter demonstrates strategies for interpreting in situations where the patient may become violent or is restrained (e.g., positioning self with ready access to the door).
  12. The interpreter demonstrates strategies for use of first and third person pronouns and what to do when the health care provider uses the first and third person.
  13. The interpreter demonstrates effective practices related to sight translationof relevant health care related documents (e.g., seeks medical staff input when unsure, medical staff present for signing forms such as surgery consent, informed consent, and other forms of a litigious nature).
    • As possible, the interpreter notes on consent forms and legally binding forms that the materials have been interpreted.

Domain 8.   Technology

  1. The interpreter demonstrates knowledge of medical technology necessary to accurately interpret a procedure (e.g., use of classifiers for colonoscopy).
  2. The interpreter is knowledgeable about video remote interpreting, pagers, video relay services and other forms of communication technology appropriate or necessary for the health care of Deaf, deaf-blind and hard of hearing individuals.
  3. The interpreter uses information technology to broaden knowledge and research specific topics related to health care.

Domain 9.   Research

  1. The interpreter remains current by reading professional journal articles and incorporating new knowledge into practice and shares this knowledge with team members (e.g., other interpreters, mentees).
  2. The interpreter critically evaluates research relevant to interpreting issues (e.g., uses appropriate analytical methods to make inferences linking research to practice).
  3. The interpreter demonstrates awareness of current health care policies.
  4. The interpreter maximizes the commonly available resources in the medical setting (grand rounds, lectures, observation of procedures) that can increase familiarity with the treatments and situations to be encountered.
  5. The interpreter continually seeks available resources in the community (e.g., maintains and adds medical related literature and resources to a personal library).

Domain 10.   Legislation

  1. The interpreter demonstrates awareness and understanding of state and federal access and legislation related health care (e.g., HIPAA, Tarasoff, ADA, 504).
  2. The interpreter demonstrates awareness of liability issues related to ineffective interpretation with grave errors, including risk to the participants and risk to the interpreter.

Domain 11.   Leadership

  1. The interpreter may serve as a liaison between interpreting services and the health care system (e.g., agencies, regional and national interpreting organizations).
  2. The interpreter may serve as a liaison between interpreter education programs and the health care system.
  3. The interpreter provides mentoring and evaluation opportunities to staff and new interpreters in the health care setting (e.g., displays positive role modeling).
  4. The interpreter promotes the establishment of policies and education that improve access for Deaf, deaf-blind and hard of hearing people to health care interpreting services.
  5. The interpreter maintains positive and strong connections to the Deaf community.
  6. The interpreter locates and uses community resources, both Deaf and non-deaf, when necessary to support their work (e.g., patient assistant, ombudsman, social worker, advocate).

Domain 12.   Communication Advocacy

  1. The interpreter demonstrates awareness of the political, sociological and cultural implications of advocacy (e.g., does not serve as an advocate when Deaf patients are capable of advocating on their own behalf).
  2. The interpreter demonstrates knowledge of resources locally and nationally that can support a patient’s health care (e.g., awareness of group homes or other facilities and entities that can assist in patients’ health care).
  3. The interpreter demonstrates understanding of health care culture and institutional hierarchy. When faced with patient care discrepancies, the interpreter reports the discrepancy to the appropriate personnel.
  4. The interpreter encourages and supports self-advocacy when possible (e.g., may discuss self advocacy with the Deaf or hard of hearing patient).
  5. The interpreter demonstrates standard and professional responses to common issues that arise regarding provider and patient rights, laws and procedures (e.g., may provide information to a patient about accessing grievance procedures).
  6. The interpreter practices effective timing of providing communication advocacy (e.g., may provide information pre-, during, or post-patient/provider interactions, improve skills and enhance knowledge for how to work with interpreters).
  7. The interpreter may work collaboratively with the Deaf community for advocacy efforts in health care settings (e.g., may present at Deaf meetings and events on health care advocacy issues).
  8. The interpreter demonstrates knowledge of the RID/NAD Code of Professional Conduct and the implications of providing advocacy. The interpreter is also aware of the NCIHC code of ethics and its position on advocacy.
  9. The interpreter provides health care providers with information about interpreting, and refers providers to Deaf, hard of hearing and deaf-blind people who can discuss Deaf culture, deafness, blindness and how the needs of individuals from these communities can be best met in the health care system.
  10. The interpreter may provide family members of the Deaf patient with information about interpreting and may discuss the communication needs of the Deaf person and how to obtain access through interpretation.
  11. The interpreter may provide Deaf, deaf-blind and hard of hearing communities with information about interpreting and how their needs can be best met in the health care system.

Domain 13.   Professional Development

  1. The interpreter stays current with practices in health care settings (e.g., immediately aware of universal precaution changes and updates, and may shadow health care personnel for educational purposes).
  2. The interpreter develops and implements annual professional development plans (e.g., assesses gaps in knowledge addressing them with measurable goals).
  3. The interpreter promotes the use of mentors from the Deaf, deaf-blind and hard of hearing communities (e.g., seeks out qualified mentors to assist in professional development activities).
  4. The interpreter attends continuing educational opportunities related to health care and interpreting (e.g., medical-related seminars, workshops and conferences).\
  5. The interpreter develops a portfolio for interpreting in healthcare, including credentials and professional experience (e.g., certifications, research, evidence of workshop attendance, independent studies).

ADA: Communicating with People who are Deaf/HH in Hospital Settings

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People who are deaf or hard of hearing use a variety of ways to communicate. Some rely on sign language interpreters or assistive listening devices; some rely primarily on written messages. Many can speak even though they cannot hear. The method of communication and the services or aids the hospital must provide will vary depending upon the abilities of the person who is deaf or hard of hearing and on the complexity and nature of the communications that are required. Effective communication is particularly critical in health care settings where miscommunication may lead to misdiagnosis and improper or delayed medical treatment.

Read more on the ADA site.

National Council on Interpreting in Healthcare

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NCIHCThe NCIHC is a multidisciplinary organization whose mission is to promote and enhance language access in health care in the United States.

The NCIHC has developed standards of practice and code of ethics for interpreters working in health care.

Download documents by clicking the links below:

National Standards of Practice for Interpreters in Health Care, September 2005
National Code of Ethics for Interpreters in Health Care, July 2004

Get more information on the NCIHC web site.

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RID’s Standard Practice Paper: Interpreting in Mental Health Settings

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RID’s Standard Practice Papers (SPPs) articulate the consensus of the membership in outlining standard practices and positions on various interpreting roles and issues.

Download a PDF of RID’s standard practice paper on Interpreting in Mental Health.

NAD Releases New Position Paper on Mental Health Interpreting Services

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From the National Association of the Deaf (NAD)

Position Statement on Mental Health Interpreting Services with People who are Deaf

The purpose of this position statement is to acknowledge and emphasize the importance and need for specialized sign language interpreting services in the delivery of mental health services to deaf individuals. While direct mental health services are optimal and always preferred, such services are not always available. When there are no direct mental health services, it is critical to ensure effective communication through specialized sign language interpreting services, which must be complete with sensitivity to cultural affiliation and awareness of the dynamics involved, in the delivery of mental health services to people who are deaf.1 The National Association of the Deaf (NAD) wishes to use this platform to increase meaningful access to mental health services by elevating the knowledge, awareness, and sophistication with respect to use of sign language interpreting by mental health professionals, healthcare delivery systems, and deaf consumers. The sections below highlight critical information for mental health providers, interpreters and the deaf community to gain a comprehensive understanding of how to better serve and support deaf individuals.

Direct vs. Interpreted Mental Health Services

The NAD recommends that individuals who are deaf be referred to specially trained providers for direct mental health services (see NAD Position Statements on Mental Health Services) whenever possible and that appropriate support services, guided by consumer choice, be made available, if necessary. In situations where it is not possible to find a service provider who is able to provide direct mental health services, or because of consumer preference, the NAD strongly recommends that service providers work collaboratively with qualified sign language interpreters who have specialized mental health interpreting expertise.

The NAD urges mental health professionals, interpreters and the Deaf Community to recognize the unique challenges faced by mental health providers and interpreters working with deaf consumers in mental health settings and to be aware that there is a need for specialized training in order to meet those challenges. The mental health care field is broad and includes both deaf and hearing service providers in the areas of psychotherapy, psychiatry, counseling and social work, psychological testing, substance abuse treatment, forensic therapy, and more. Settings may range from a client’s home, private offices, hospitals and prison facilities.

According to the Registry of Interpreters for the Deaf’s (RID) Standard Practice Paper on Interpreting in Mental Health Settings, “Mental health professionals depend heavily on language form and content for diagnosis and treatment. Nuances in communication, including affective tone and subtleties of language structure, may be significant for diagnosis and treatment effectiveness.” (RID, 2007). While there is great variability in ability to recognition of mental health terms in English by hearing people, a reliable study exploring cultural and linguistic barriers to mental health service access found that deaf participants’ ability varied even more widely (Steinberg, Sullivan, & Lowe, 1998). In addition to understanding terminology specific to mental health settings, interpreters face complex interpersonal dynamics stemming from the symptoms of psychological disorders, diagnostic and treatment goals specific to various mental health settings, as well as the unique communication and therapeutic objectives of each member of the mental health treatment team.

Interpreters are encouraged to adhere to high standards of ethical practice (RID, 2007), which includes ensuring that they have appropriate training in mental health interpreting prior to accepting work in such settings. Interpreters need to be prepared for a variety of group dynamics including but not limited to: hearing clinicians working directly with deaf consumers; hearing clinicians working with deaf consumers and their hearing family members or partners; and deaf mental health professionals with various interpreting needs. These scenarios present their own challenges and complications (Hauser, Finch, & Hauser, 2008) and interpreters would benefit from training and preparation in order to be qualified for such jobs.

Credentials in Mental Health Interpreting

Though the RID lists standards of practice in mental health interpreting, as of early 2012, RID does not have any specialist certification for mental health interpreting.2 There are several independent programs focusing on mental health interpreting, but there is no uniformity in those programs. The only known certification program that provides intensive training in mental health interpreting is offered through the Alabama Mental Health Interpreter Training. (Alabama Department of Mental Health Administrative Code, 2003; Crump, 2012).

Requirements of Mental Health Interpreters:

Intrapersonal Awareness

While mental health professionals are trained to deal with patients and situations that are emotionally charged, most interpreters are not. As such, interpreters working in the mental health setting must have keen intrapersonal skills in terms of strong awareness of biases and values, triggers, limitations, and potential for countertransference. The ability of the interpreter to self-manage and remain calm during a mental health interpreting assignment is paramount to a successful mental health session for the deaf consumer. Intrapersonal skills can be developed with training, supervision, and peer support, and such skills can guide decisions on accepting jobs in this field. A few aspects of the assignment to consider prior to accepting the job would be: culture, race, gender, religious affiliation, and sexual orientation.

Expertise in Language and Culture

In order to avoid misdiagnosis in deaf consumers, it is critical that interpreters not only have receptive and expressive fluency in American Sign Language, but are extensively trained in mental health techniques. Mental health interpreters must be familiar with and able to utilize different interpreting modalities. Furthermore, the interpreter must be prepared to educate providers on the possible need for longer sessions, the need for appropriate pausing during sessions, or changes in how questions are posed. Providers may rely on interpreters for cultural information. For optimal results, the interpreter’s communication with the service provider and the consumer prior to the first session is critical (Hamerdinger & Karlin, 2003).

Some deaf consumers, especially those with a lifetime experience of mental illness, may also have limited language or information deficits. This can make it much more difficult for a provider working through an interpreter to appropriately differentiate between such deficits and symptoms of mental illness. It is important to ensure that the interpreting process does not mask the language deficits of consumers as clinicians rely on accurate interpretation to make inferences about mental processes (Crump & Glickman, 2011).

Confidentiality & Professional Boundaries

Throughout the United States, limited resources often restrict options for interpreter services. Deaf consumers may encounter the same interpreters at general life events or appointments that were present for their mental health appointments. These encounters could create some conflicts or discomfort for both the individual and the interpreter. Maintaining confidentiality becomes even more crucial.

Confidentiality in mental health interpreting requires a level of discernment and critical thinking unique to this setting. The NAD-RID Code of Professional Conduct encourages interpreters to “share assignment-related information only on a confidential and ‘as-needed’ basis (e.g., supervisors, interpreter team members, members of the educational team, hiring entities)” (RID, 2005). While it is important for the interpreter to receive some information on what has been happening with a deaf consumer’s treatment, there must be strict protocols to maintain confidentiality. When communicating in writing, it is imperative that interpreters learn standards of such communication, be aware that such communication may become a part of the client’s official file and understand relevant confidentiality laws such as HIPAA and Federal Regulation 42 CFR, Part 2.

Ethics, Supervision & Peer Consultation

Mental health providers are expected to adhere to high standards of ethical practice.3 In mental health work, there is higher risk for abuse of power, vicarious trauma, boundary crossings, and burnout. As such, providers are encouraged to engage in regular supervision and peer consultation. Interpreters working in such settings need to be held to the same standards and benefit from the opportunity to work with supervisors and/or consult with peers (Atwood, 1986; Fritsch-Rudser, 1986; Dean & Pollard, 2009, 2011; Keller, 2008; Hetherington, 2011; Anderson, 2011). In order to achieve higher standards of supervision in mental health interpreting, the NAD recommends building a pool of experienced interpreters who are qualified to perform supervision and are available to work with new mental health interpreters on a national level.

Qualified Mental Health Interpreters

The NAD recommends the following qualifications for interpreters working in mental health settings:
1. Fluency in American Sign Language;
2. Fluency in English and register choices;
3. Culturally competent;
4. Attending a comprehensive training curriculum for mental health interpreting
5. Mentoring with experienced mental health interpreters (at least 50 hours);
6. Individual or group supervision and peer consultation;
7. High standards of ethical practice; and
8. Knowledge of relevant ethical literature or decision-making models in interpreting.

The NAD recommends that a certification process for specialization in mental health interpreting be set up through nationally recognized means. Alternatively, a standardized portfolio system can be used to emphasize the individual’s specialization in mental health interpreting. It is also recommended that interpreters maintain their skills with continuing education in the area of mental health with every certification cycle (15 hours annually or 60 hours per four year RID certification maintenance program cycle). To achieve this, developing more options for seminars to meet the required 60 hours of continuing education in a four year period in the area of mental health is critical. In order to recruit more interpreters specializing in mental health interpreting, the interpreter training programs are encouraged to provide students at least one class focusing solely on mental health interpreting for a full quarter or semester to capture their interest in this specialization.

In summary, mental health interpreters are an important component in the mental health delivery system for deaf individuals with mental health needs, as they provide auxiliary services when a service provider is unable to deliver direct mental health services or when a deaf consumer requests it. While the field of mental health interpreting has aimed to set higher standards over the past decade, this position paper hopes to raise the standards by defining qualifications, expanding the credentials and requirements for mental health interpreters, as well as addressing the professional boundaries, ethics, supervision, and peer consultation in this profession.

Notes

1 The term “deaf” is to be interpreted to include individuals who are hard of hearing, late deafened, and deaf-blind.

2 See www.rid.org/education/testing/index.cfm

References

Alabama Department of Mental Health. (2003). Chapter 580-3-24, Mental health interpreter standards. Retrieved from http://www.alabamaadministrativecode.state.al.us/docs/mhlth/3mhlth24.htm.

Anderson, A. A. (2011). Peer Support and Consultation Project for Interpreters: A Model for Supporting the Well-Being of Interpreters who Practice in Mental Health Settings. Journal of Interpretation, 21(1), pp. 9-20.

Atwood, A. (1986). Clinical supervision as a method of providing behavioral feedback to sign language interpreters and students of interpreting. In M. L. McIntire (Ed.). New dimensions in interpreter education: Curriculum and instruction (pp. 87-93). Proceedings of the 6th national Convention of the Conference of Interpreter Trainers. Chevy Chase MD.

Crump. C. (2012). Mental Health Interpreting Training, Standards, and Certification. In K. Malcolm and L. A. Swabey (Eds.). In Our Hands: Educating Healthcare Interpreters. (pp. 54-76). Gallaudet University Press. Washington, D.C.

Crump, C. & Glickman, N. (2011). Mental Health Interpreting with Language Dysfluent Deaf Clients. Journal of Interpretation, 21(1), pp. 21-36.

Dean, R. K. & Pollard, R. Q. (2011). The importance, challenges, and outcomes of teaching context-based ethics in interpreting: A demand control schema perspective. Interpreter and Translator Trainer, 5(1), pp. 155-182.

Dean, R. K. & Pollard, R. Q. (2009, Fall). “I don’t think we’re supposed to be talking about this:” Case conferencing and supervision for interpreters. VIEWS, 26, pp. 28-30.

Fritsch-Rudser, S. (1986). The RID code of ethics, confidentiality and supervision. Journal of Interpretation, 3, pp. 47-51.

Hamerdinger, S., & Karlin, B. (2003). Therapy using interpreters: Questions on the use of interpreters in therapeutic settings for monolingual therapists. Journal of American Deafness and Rehabilitation Association, 36(3), pp. 12-30.

Hauser, P. C., Finch, K. L., and Hauser, A. B. (2008). Deaf Professionals and Designated Interpreters: A New Paradigm. Gallaudet University Press. Washington, D.C.

Hetherington, A. (2011). A Magical Profession? Causes and management of occupational stress in sign language interpreting profession. In L. Leeson, S. Wurm, M.

Vermeerbergen (Eds.). Signed Language interpreting: Preparation, practice and performance (pp. 138-159). St. Jerome Publishing. Manchester, UK.
Keller, K. (2008). Demand-control schema: Applications for deaf interpreters.

In L. Roberson & S. Shaw (Eds.). Proceedings of the 17th National Convention of the Conference of Interpreter Trainers: Putting the pieces together: A collaborative approach to excellence in education. (pp. 3-16). Conference of Interpreter Trainers. San Juan, PR.

Steinberg, A. G., Sullivan, V. J., and Loew, R. C. (1998). Cultural and Linguistic Barriers to Mental Health Service Access: The Deaf Consumer’s Perspective. American Journal of Psychiatry, 155(7), pp. 982-984.

Registry of Interpreters for the Deaf (RID). (2005). NAD-RID Code of Professional Conduct. Retrieved from http://www.rid.org/UserFiles/File/NAD_RID_ETHICS.pdf.

Registry of Interpreters for the Deaf (RID). (2007). Standard Practice Paper on Interpreting in Mental Health Settings. Retrieved from http://www.rid.org/UserFiles/File/pdfs/Standard_Practice_Papers/Mental_Health_SPP.pdf.

Mental Health Context-Therapuetic Dynamics, Interpreting Therapeutic Discourse, The Interpreter as Professional

Mental Health DOMAINS AND COMPETENCIES

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DRAFT January 31, 2007 | Download PDF

Domain I. Mental Healthcare Context

A. The interpreter will demonstrate knowledge of abnormal psychology and common diagnoses, esp. specific psychological disorders that have significant implications for communication and interpreting.

1. DSM IV Classifications/Axes.
2. Medications and their impact on language and behavior, (e.g., articulation, fluidity, facial affect, etc.).
3. Substance abuse.
4. Prevalence of childhood trauma and sexual abuse in psychiatric populations, (i.e., hospitalized or chronically mentally ill).
5. Bi-lingual facility with technical vocabulary pertaining to common disorders and treatment terms.
6. Medical etiologies and syndromes common in deaf, deafblind, hard of hearing mental health populations (e.g., organic brain syndrome, developmental disabilities, learning disabilities, Traumatic Brain Injury, Usher Syndrome, etc.) and their impact on communication.
7. Populations served including demographics (age, culture, ethnicity, education, and gender), world views, risk factors, and fund of information variables.

B. The interpreter will demonstrate knowledge of treatment protocols (policies, goals, dynamics, interventions, procedures) and the ability to work safely in the many settings of the modern continuum of care: emergency department, trauma situations (domestic violence, sexual abuse, etc.), crisis intervention, long term acute, and partial hospital care, residential, rehabilitation, intervention, long term, acute, and partial hospital care, residential rehabilitation, out patient (individual, group, adult, children), adult and child protective services, substance abuse\settings as well as knowledge of other therapeutic settings, (e.g.,admission and assessment procedures in secure and mandatory hold settings).

C. The interpreter will differentiate the purposes and goals of treatment plans and diagnostic assessments such as the Mental Status Exam, psychological testing and homicidal, suicidal, and self-harm assessments, etc.

D. The interpreter will demonstrate knowledge of the goals, procedures, and interventions of common therapeutic approaches used in mental health systems and how language and communication impact these different interventions, such as Cognitive Behavioral Therapy (CBT)/Dialectical Behavioral Therapy (DBT), EMDR (Eye Movement Desensitization Reprocessing), Family Systems Therapy, etc.

E. The interpreter will demonstrate knowledge of the objectives and procedures involved in the common approaches and intervening variables in substance abuse treatment such as detox, 12 step programs, relapse prevention, etc.

F. The interpreter will demonstrate understanding of the roles and functions of mental healthcare providers including psychiatrists, psychologists, psychiatric nurses, technicians, etc.

G. The interpreter will identify common forensic mental health areas, issues and interpreting situations, (e.g., NGRI: not guilty by reason of insanity, competency to stand trial, involuntary commitment, etc.).

Domain II. Therapeutic Dynamics

A. The interpreter will demonstrate an understanding of common and complex therapeutic dynamics, especially 3rd party dimensions, and the interpreter’s potential impact and interference on the therapeutic process/relationship.

1. Understand how the presence of an interpreter alters the dynamics of transference, counter-transference, etc., (e.g., –>interpreter transference, patient –>provider, (possible) provider–>interpreter, family dynamics –>interpreter, and (possible) interpreter counter-transference –>patient).

a. negotiate with the provider, strategies to minimize the interpreter’s presence in the therapeutic triad.
b. demonstrate the ability to manage these dynamics through
pre-/post-sessions, de-briefing, case conferences, multidisciplinary
supervision and mentoring.

2. Demonstrate an understanding of how linguistic choices can trigger reactions from the consumer as well as the therapist, affecting the participants’ reactions to each other.

B. The interpreter will demonstrate the ability to maintain professional boundaries, especially in situations and settings where boundaries are frequently challenged and to know what the special mental health-interpreting boundary challenges are.

1. Demonstrate ability to establish appropriate rapport and boundaries with consumer.
2. Articulate unique boundary challenges in the mental health settings (arising from consumer of mental health services, multiple roles, etc.) and how these differ from non-MHI assignments, decision making and consequence levels.
3. Understand notions of “confidential [trust] supervision and total silence” (what information can/should not be shared and with whom) and work with the provider to offer the consumer an understanding of what information will be shared within the team.

C. The interpreter will articulate how boundary challenges in mental health interpreting impact personal safety and mental well being and the need for the interpreter to develop personal care plans.

1. Demonstrate strategies for remaining physically safe in the various provider settings.

a. know the provider’s procedures and techniques of securing unstable patients, the extent of the interpreter’s responsibility for the consumer’s safety and how that would impact the safety of the interpreter.
b. follow Universal Precautions.
c. advocate for safe working conditions, (e.g., how to negotiate when asked to escort the consumer with no other staff present in an inpatient environment).

2. Describe and recognize vicarious trauma and develop strategies for self-care.

D. The interpreter will demonstrate ability to recognize, monitor and manage his/her own reactions to the content of the therapeutic session without imposing his/her reactions on either the provider or consumer.

1. Be aware of how to manage personal biases, sensitivities, “-isms,” and able to explore personal motivations.
2. Establish a formal structure in which to manage personal issues outside of interpretation settings.
3. Be able to discuss with the providers and colleagues the limitations of interpreting and why interpreted treatment is not equivalent to direct treatment.

Domain III. Interpreting Therapeutic Discourse

A. The interpreter will demonstrate understanding and decision-making ability concerning the use of consecutive and simultaneous interpretation.
B. The interpreter will demonstrate skills in providing linguistic and cultural equivalences to mirror the therapeutic interaction.

1. Demonstrate precise linguistic choices that match the source language in the discourse, realizing that linguistic choices can impact the dynamics of the therapeutic setting, (e.g., metaphor, mental health jargon, culturally rich realities and intentionally vague communication, etc.).
2. Recognize and be able to interpret linguistic and extralinguistic nuances of therapeutic communication, (e.g.,compassionate feedback, emotional hesitancy, etc.).
3. Provide needed cultural information seamlessly.

C. The interpreter will be able to interpret language unique to particular topics and groups, (e.g., substance abuse, sexual habits and orientation, etc.).

D. The interpreter will demonstrate ability to identify and respond
effectively to the presence of a variety of dysfluency patterns and
symptoms.

1. Demonstrate ability to detect dysfluent language.
2. Develop rich skill sets for responding to dysfluency, (e.g., 1st or 3rd person narrative, description, team interpreting strategies, hearing/hearing interpreter teams, deaf/hearing interpreter teams, trilingual teams).
3. Demonstrate skill in judging when/how/who to share knowledge/evidence of possible language dysfluency in an effective, accurate, and helpful manner, including helpful resources, and/or outside help.

E. The interpreter will demonstrate ability in interpreting for common non-forensic mental health dialogue/procedure topics, e.g., suicide risk assessment, Mental Status Exam, intake diagnostic interviews, clinical assessment, etc.

Domain IV. The Interpreter as Professional

A. The interpreter will demonstrate the ability to serve in a professional capacity on the multidisciplinary treatment team and understand other team member’s role with constant emphasis on maintaining the role of the interpreter.

1. Develop an identity and belief as a practice professional.
2. Understand what contributions, roles and boundaries each team member, including the interpreter, brings to the therapeutic process.
3. Understand and actively engage the professional interpreter role in the context of agency structure, dynamics, and public mental healthcare realities, trends, policies, etc.
4. Understand the similarities and differences between working as a staff interpreter and working as a freelance community interpreter.
5. Demonstrate respectful “people first” language (e.g., “people with schizophrenia”) at all times when communicating with providers, etc.
6. Team professionally with both deaf and hearing teams as appropriate.

B. The interpreter will anticipate areas of potential conflict at the interface of interpreting and mental health services regarding decision-making, problem-solving abilities, and resources in ethical codes of conduct, goals of providers, and triadic encounters.
C. The interpreter will demonstrate the ability to access a variety of problem-solving principles and resources to analyze and resolve impediments to effective interpreting, (e.g., Demand-Control Model, conflict resolution models, etc.).
D. The interpreter will demonstrate problem-solving strategies and resources.

1. Communicate with mental health providers about working effectively with interpreters.

a. analyze effectiveness of the interpretation, monitor understanding and effectively communicate that to provider.
b. demonstrate strategies for explaining distinctions in discourse styles, (e.g. role of narrative, abstract concepts,use of names).
c. able to discuss with the provider the compatibility of level of therapeutic interventions as evident in consumer discourse.

2. Develop team relationship/collaboration with providers.

a. provide information about language use patterns, abstract thinking, etc., (e.g., in connection with Mental Status Exam).
b. recognize and draw on available resources to effect communication, (e.g., group home staff, family members).
c. establish and share resources.

3. Appropriately advocate/consult around language and culture issues (culture broker) that could lead to misdiagnosis.

a. clarify as necessary to the provider assumptions/misconceptions around typical ASL behaviors (e.g. eye gaze, facial affect).
b. negotiate opportunities for interpreters to assess consumer language capabilities, word choice, language functioning while in the presence of the provider.
c. understand and be able to articulate to the provider, the impact of a deaf, deafblind, and hard of hearing person’s presence on group dynamics.
d. understand and be able to articulate to the provider the impact of interpreter’s presence on group dynamics.
e. analyze where responsibility lies in managing communication in group work and negotiate with provider
to achieve goals of the group with respect for deaf or deafblind cultures and rules of turn taking, role of storytelling in the culture.
f. negotiate challenges of working with multiple languages, consecutive interpreting, teamwork among interpreters (as in multicultural, multiethnic populations).

E. The interpreter will demonstrate a thorough knowledge of
relevant professional literature.

1. Know current mental health interpreting standards or certifications, and the Registry of Interpreters for the Deaf, Inc. Standard Practice Papers.
2. Be familiar with key literature, (e.g., history, epidemiology, ethics, evidence-based treatments, future trends, crosscultural issues, and people of color who are deaf, deafblind, and hard of hearing).

F. The interpreter will demonstrate commitment to ongoing education, self-care and life long learning.

1. Establish avenues for supervision, debriefing, mentorship, collegial support and consultation.
2. Develop resources and strategies for dealing with unsuccessful, unresolved cases, unaccomplished goals due to constraints placed on interpreter that prevent effective interpretation, detaching own value of self as professional from outcome when out of interpreter’s control.

G. The interpreter will understand interpreter’s role and responsibility in connection with applicable legal and ethical mandates and policies: HIPAA, duty-to-warn (Tarasoff), Child Protective Services, Adult Protective Services, legal privilege, etc., and is able to determine need to report and knows reporting procedures.