Reflections from Doug Bowen-Bailey and Karen Malcolm attending the 2nd National Symposium on Healthcare Interpreting.

Sign to the Emergency Department at Hospital

Medical Interpreting Immersion Rochester

October 20-23 2016

Unity Hospital 1555 Long Pond Rd, Rochester, NY 14626
Registration and cancellation policy: WWW.dmsquaredllc.com

Presented in American Sign Language, this four-day intensive workshop offers application of anatomy and physiology in American Sign Language, with an emphasis on classifiers, specialized terminology used in medical settings, in-depth discussion of interpreting considerations for medical settings, and ethical decision making strategies especially for medical settings.

This workshop is open to 24 interpreters. We would like to have a balance of Deaf and Hearing attendees and priority will be given to certified Deaf and hearing interpreters with at least 3 years interpreting experience. 12 seats will be available to each until September 30, at which time the remaining seats will be open on a first come, first serve basis.

Thursday- Saturday 8:30 AM- 4 PM

Sunday 9 AM- 12:30PM

Workshop cost, including CEUs: $250

RID Certification Maintenance Program logo2.3 CEUs, Professional Studies, Content Level: Some, offered through The Language Door, an approved RID CMP & ACET sponsor. Activity #0264-1016-01/WRKSP-30476-LRUK

Registration and cancellation policy: www.dmsquaredllc.com

Questions email: dawn@dmsquaredllc.com

Click here to download a PDF flyer: rochester-medical-flyer-oct

Welcome

Book Review: “In Our Hands”

As a participant in the symposium, I was a bit surprised that this volume on educating healthcare interpreters did not get more attention at the symposium. It was mentioned briefly and given away as a door prize, but having read through much of it, I think it merits more consideration than it received.  So, I am giving it some here.

This is an overview of it that I put together for healthcareinterpreting.org.

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Laurie Swabey and Karen Malcolm have edited a volume which significantly expands the resources for our field in educating interpreters for healthcare settings.  The volume, In Our Hands:  Educating Healthcare Interpreters, was published in 2012 by Gallaudet University Press and is the fifth volume in the Interpreter Education Series.

Here is the description from the back of the book:

Deaf Americans have identified healthcare as the most difficult setting in which to obtain a qualified interpreter. Yet, relatively little attention has been given to developing evidence-based resources and a standardized body of knowledge to educate healthcare interpreters. In Our Hands: Educating Healthcare Interpreters addresses these concerns by delineating the best practices for preparing interpreters to facilitate full access for deaf people in healthcare settings.

The first section of this volume begins with developing domains and competencies toward a teaching methodology for medical and mental health interpreters. The next chapter describes a discourse approach that relies on analyzing actual transcripts and recordings to train healthcare interpreters. Other chapters feature a model mental health interpreter training program in Alabama; using a Demand-Control Schema for experiential learning; the risk of vicarious trauma to interpreters; online educational opportunities; and interpreting for deaf health care professionals. The second section offers four perspectives on education, including healthcare literacy of the clients; the education of Deaf interpreters; the development of standards for spoken-language healthcare interpreters; and the perspectives of healthcare interpreter educators in Europe. The range and depth of In Our Hands takes significant strides in presenting educational opportunities that can enhance the critical services provided by healthcare interpreters to deaf clients.

Here’s a listing of the contents:

  • “Domains and Competencies for Healthcare Interpreting:  Applications and Implications for Educators” by Laurie Swabey and Quincy Craft Faber
  • “‘What Happens Truly, Not Textbook!’: Using Authentic Interactions in Discourse Training for Healthcare Interpreters” by George Major, Jemina Napier, and Maria Stubbe
  • “Mental Health Interpreting:  Training, Standards, and Certification” by Charlene Crump
  • “Beyond ‘Interesting’: Using Demand Control Schema to Structure Experiential Learning” by Robyn K. Dean and Robert Q. Pollard
  • “An Ounce of Prevention Is Worth a Pound of Cure: Educating Interpreters about the Risk of Vicarious Trauma in Healthcare Settings” by Karen Bontempo and Karen Malcolm
  • “Just What the Doctor Ordered? Online Possibilities for Healthcare Interpreting Education” by Doug Bowen-Bailey
  • “Educating Interpreters as Medical Specialists with Deaf Health Professionals” by Christopher Moreland and Todd Agan
  • “Health Literacy and Deafness:  Implications for Interpreter Education” by Teri Hedding and Gary Kaufman
  • “Deaf Interpreters and Mental Health Settings:  Some Reflections on and Thoughts about Deaf Interpreter Education” by Pamela Morgan and Robert Adam
  • “Professionalizing Healthcare Interpreting between Spoken Languages:  Contributions of the National Council on Interpreting in Health Care” by Bruce Downing and Karen Ruschke
  • “Educating Sign Language Interpreters in Healthcare Settings:  A European Perspective” by Maya De Wit, Marinella Salami, and Zane Hema

The book is available from Gallaudet University Press in both a print version and as an e-book.  For more information, click here.

Wrapping Up

I am sitting on my front porch in the dark now, waiting for the cool of the evening. It has been quite a few days for me.  I ended the symposium facilitating a discussion on a framework for teaching healthcare interpreting online and that was a nice change of pace for me to switch from my blogging role to presenting.  It was a great discussion that we had, and I was glad to explain the framework behind some of the resources that I have been a part of creating. I have to admit, however, that there was a great part of me that just wanted to have a collegial discussion reflecting on all of the information and new ideas that I encountered over the past 3 and a half days.   Fortunately, we were able to do some of that in discussing how to structure online materials that incorporate and support the new paradigm of an interpreter as a practice professional (or holistic interpreter.)

I also have to say that doing the blog has been quite an experience for me.  I definitely was a  more focused participant because I had the task of reflecting on what I was taking in in this forum.  Great opportunity to develop my professional voice.  What has been especially gratifying is to have the discussion with people at the end of the symposium who have really appreciated finding out that this blog will be a resource that will continue to be accessible.

The plan is to allow the discussion to continue for the next week or so – and allow anyone to post comments and share reflections on here.  After that, we’ll shut down the comments – because some site maintenance is needed to prevent spammers from filling up the comments section.  The blog itself, with all of the information and resources, will continue to be available into the foreseeable future.  (In my workshop, I said that it will be “as long as electrons flow.”)  The beauty of a blog like this is that it can archive past postings and pages.  So, we’ll shift from the menu on the top reading “Symposium Schedule” to 2012 Symposium.  That means that in 2014, we can start a new menu item on top with offerings that can be the basis for a future discussion.

Personally, I have also been doing some reflecting on my future role at conferences.  I have done my share of organizing, presenting and/or interpreting for conferences, and have felt I have made contributions in doing that.  Yet I have shared with others that I might consider putting in proposals in the future not to present at conferences, but to set up and facilitate a blog such as this.  I really do think that forums such as this have the potential to not only expand the geographic reach of an event such as this symposium, but also expand its temporal reach – serving to archive the information in an accessible format for the future.  One of the conversations I had was with Cynthia Roy who in many ways has been a pioneer in the field of interpreter research.  But, like myself, she is also a history major, so she appreciates the importance of understanding our past as we move into our future.  She and Jemina Napier are currently working on a new project collecting essays from our past as a field so that history is available to those people who are just now entering it.  I am glad to know that this symposium will be able to join our permanent record as a field without burdening Jemina or Cynthia with the task of capturing it.  It will simply be here for all of us.

So, thanks to the CATIE Center and all the people responsible for making the symposium happen.  Thanks to all the presenters who so graciously shared so much insight in the sessions and information to be included on the blog.  I am so grateful to have shared this opportunity with Karen Malcolm who, as always, has been a pleasure to work with.  Finally, thanks to all of the people who took part in the symposium and took part in so many incredible conversations to move our profession forward.

Responses to question 3 from Wed. morning

the panel on examining discourse in healthcare that was presented on Wed. morning ran out of time for panelists to offer their response to the final question, so we will post some of those responses here.

The question: What is one recommendation you have that practitioners or educators could immediately apply?

Karen’s response:
I think role plays of medical interaction, with Deaf participants, are extremely beneficial. It’s even more helpful if the “healthcare practitioner” in the role play is actually a hearing HCP who doesn’t know ASL but my experience is that it’s been difficult to find people to fill this role. Deaf people understand the importance of developing interpreters’ skills, and are more willing to give of their time. (By the time, I think they should always be offered some kind of honorarium or payment in compensation.)

Having both a Deaf and hearing interpreter observe the role play, to offer their feedback and suggestions, is very useful. It’s also helpful to have developed some talking points for the discussion to counteract the artificiality of the situation. So the “doctor” should know whether they’ve met the patient before, and what the issue is they’ll be presenting, while the Deaf patient should have some points of what they want to cover. There should also be a card for the interpreter, giving them some basic information, and then let them have the opportunity to meet the Deaf patient prior to the appointment with the doctor, and ask whatever questions they think would be useful.

For people who are working in an academic institution, you may be able to partner with a health sciences or nursing program at the institution, so that students in the program role play the healthcare practitioner. It increases the authenticity of the interaction, as well as providing some exposure and education for the students.

I attended Kathy Miraglia’s presentation on the new Certificate in Healthcare Interpreting that NTID has established. there is a wonderful opportunity there to observe real interactions, between hearing participants (healthcare provider and patient), with no Deaf person or interpreter involved, and then between Deaf HCP and Deaf patients, with no interpreter, before viewing interpreted interactions. This seems like an excellent way to learn. However, given that many of us don’t have access to these kinds of resources…yet?….role plays do offer a rich opportunity for learning and reflection.

Perspectives on Research

During the 11:00 hour, I jumped between two sessions looking at research.  The first was “From the Horse’s Mouth” by Lori Whynot and then “When a Research Plan Does Not Goes as Planned” by Cynthia Roy.

The former used qualitative interviews and an online survey of experienced in healthcare interpreting in two urban areas.  The latter was set up to video interpreted interactions in a variety of settings to have actual interactions to analyze.  One of the commonality between the two was that there was an emphasis in looking not at errors, but how interpreters make things work.

Check out the pages for each of these.  We’ll try to get their presentations posted online so you can check it out.  It would be great if other attendees could share some perspectives on these two presentations.

Panel on Examining Healthcare Discourse

First of all, I want to say a word of appreciation to the people who talked to me and shared that they are indeed reading this blog and are thankful for the work that Karen and I are doing in trying to share information and our perspective on the symposium.  It’s good to know that this is proving to be successful in expanding the impact of this event.

For Wednesday morning’s panel, I did some live blogging as comments on the page regarding the panel.  You can see it here.

Reflections from a Holistic Presentation Team

This post was written by Patty Gordon with input from  Dr. Rachel St. John, Jay Moradi-Penuel, Todd Agan, and David Evans.

Presenter Dr. Rachel St. John, Interpreter David Evans, presenter Jay Moradi-Penuel, Interpreters Todd Agan and Patty Gordon

This is an image from the session “The Healthcare Interpreter as a Practice Profession Specialist” presented by Jay Moradi-Penuel and Dr. Rachel St. John. The theme of the presentation was focus on the interpreters working collaboratively with the rest of the healthcare team and serendipitously ended up being modeled in front the participants’ eyes.  The session started typically enough with the two presenters and one sign language interpreter on stage.  As it became clear the presenters had a close connection and were engaging with each other throughout the presentation, the support interpreter came on stage and took on the role as the second presenter so, as Dr. St. John put it; “The team of 2 presenters became a team of 4.”  Eventually a third sign language interpreter was brought in to represent the audience questions, so each speaker was represented by a designated interpreter and the audience by a third.  Now the team was 5.  While conference interpreters, often designate ourselves to one person when voice interpreting multiple presenters, we usually don’t see this done from English to ASL and none of the team of 5 had experienced anything quite like today’s arrangement.

In the end, the Deaf participants said they very much appreciated the set-up. Normally, with two presenters and one interpreter, the Deaf audience can lose track of which speaker the interpreter is representing at any given time.  With two interpreters, it was always clear to the viewer who was speaking.  The addition of the third made the entire event much more representative of the actual variety of speakers in the room.  The presenters found the process extremely easy, enjoyable and productive.  The interpreting team, while having to be “on” for the entire session, found they were not as exhausted as they might have been with the standard 20 minute switch out and felt they were able to successfully represent not only the content but the spirit and interactiveness of the presentation.

The entire team of 5 spent time debriefing the event and agreed there is much to explore as to why this worked so well, particularly with no advance plan.  Early thoughts about the success of the effort are:

  • The presenters are also interpreters and not only understood the choices being made, but trusted the interpreting team to do what seemed to work best at any given moment.
  • The interpreters are also presenters and have an understanding of what presenters are doing, the purpose behind choices made to engage the audience, deliver information, manage the environment, etc. and were able to keep the focus directed on the presenters and the content.
  • The presenters and the interpreting team share a deep belief in the commitment to work as a team in a holistic manner, even though they did not necessarily know they shared that belief at the time.
  • The interpreting team was operating under a set of norms that included thinking of the entire conference team as one team, making it possible to easily expand or adjust team placement at any time with no sense of territorialism or individual ownership of the message or process.  The stated goal for the team (and this was developed and posted in the interpreter’s room) was to “embrace the concept of teamwork – the end product of our work together is communication access.”  An additional goal was to “model extremely effective team and conference interpreting”.   This meant when the first interpreter had the impulse to add the additional interpreters and bring the idea of a third interpreter to the table over lunch, the rest of the team was open to and willing to try an approach that would meet those goals.
  • The interpreters in the session trusted each other, supported each other and had already established a rapport in the days before this session.
  • There was a common approach of language use, sense of humor and overall delivery style among the 5 individuals, thus the product sounded and looked cohesive.
  • And, finally, the Deaf participants found the arrangement very effective and wanted it to continue through the presentation, reinforcing the commitment everyone had on the team to communication access.

What questions does an arrangement like this evoke for you?  Have you as an interpreter or presenter worked with a team of interpreters this way?  All five of the people on this stage are very interested in exploring this further.

The 5 P’s of Preparation

I Just came from the workshop, The 5 P’s of Preparation, led by Christa Moran and Andi Chumley.  I encourage you to look at their powerpoint, because they’ve provided an easy to understand, easy to use approach to considerations of what we need address when providing healthcare interpreting. The 5 P’s are purpose, people, place, procedures and potential outcomes.

Christa and Andi pointed out that prior to surgery, everyone involved is prepared: doctors, nurses, technicians…and that for an interpreter to walk in unprepared negatively affects the whole team.  They then led us through a discussion of the 5 P’s, elaborating on each of them to flesh out their significance. (No pun intended on “flesh out”. Perhaps the fact that I even thought to mention this is indicative of a level of fatigue setting in from the very long, thought-provoking days! J)

I appreciated their discussion on our interaction with the hearing personnel in the setting. They reminded us that these are our clients as well, and that we have an opportunity to offer information to them, to educate them about better serving Deaf patients. This resonated with one of the points Anna and Brenda raised in their afternoon presentation about relational autonomy.

Another point Christa and Andi emphasized was the importance of knowing our boundaries, and the roles of other healthcare practitioners.  We need to consider our scope of practice, and if a certain activity is out of our scope of practice, is there a way we can locate the person whose scope it is, and then provide interpretation between them and the patient as needed?

In summary, as I stated above, this approach is a helpful one to use as a checklist prior to interpreting, and also helpful for educating interpreters new to this setting.

You can check out their presentation here.

On Relational Autonomy

On Tuesday afternoon, I took part in the workshop on “Relational Autonomy” presented by Brenda Nicodemus and Anna Witter-Merrithew.  This concept grew out of a think tank sponsored by the NCIEC on specialization.  This group was facilitated by Anna Witter-Merrithew and included Steven Collins, Eileen Forestal, Sharon Neumann Solow, Brenda Nicodemus, Marty Taylor, and Kevin Williams.

The discussion focused on the efforts to shift paradigms in our profession, moving from the prevailing paradigm of interpreters as technicians to interpreters as practice professionals.

Image from Witter-Merrithew and Nicodemus

In some ways, it was another angle on the discussion that was taking place in the ballroom that was being facilitated by Dr. Rachel St. John and Jay.  So, I think these concurrent workshops show how important it is for our profession to be having this conversation.

From this specific workshop, I took away several significant things points.

1) How important it is for us to develop our “professional voice” to be able to create a presence that contributes to collaboration.  Too often, our perspectives on the consumers we work come from a more antagonistic approach.  Part of this voice needs to move from an interpreter-centric approach which focuses on “our needs as an interpreter” and can appear to be self-serving and moves to a system-centric approach that understands all the forces and resources that the different participants bring to the situation, and then the way that the interpreter can support the communication goals of all of those involved.  It also involves a change in perspective when the hearing people we work with do not understand how to work with an interpreter.  Instead of being a cause for frustration, it can be an opportunity for us to practice our professional voice in explaining what we do and how we can best work together.

2) We need to move away from the “myth of neutrality” as named by Melanie Metzger because it creates a sense of aloofness and disconnectedness from the communication process.  Anna shared several ASL renderings of the concept of “neutral” that have been characteristic of our prevailing paradigm, and then showed another way to talk about interpreter’s sense of engagement in a more collaborative way.  See the video clip below for this difference.

A significant difference in how that appears to the people we work with.

3) Looking at issues of autonomy provides us better ways for applying the demand-control schema.  Anna and Brenda referenced Dean and Pollard’s work on a continuum of ethical decision-making moving from more conservative approaches to more liberal approaches.

Graphic developed by Robyn Dean and Dr. Robert Pollard

I have found this to be extremely useful concept in my own practice and in my mentoring work.  This workshop, however, provided me a helpful framework to approach using this continuum.  Here were the criteria shared:

  • The more balanced the the autonomy expressed by participants, the more likely the interpreter is to exercise conservative choices.
  • The less balanced the autonomy expressed by participants, the more likely the interpreter is to exercise liberal choices.

I really appreciate having that as a way to talk about how to think about shifting the lines of what is ethical and what is not.  Anna’s point that she made again and again is that is easier to hide our conservative unethical acts because they don’t show up.  If we act too liberally, it tends to show up and then can be a teachable moment.  But if we don’t act when action is warranted and it causes harm to our consumers, that is harder to identify.

Through the use of group discussion and case studies, this workshop really spurred my thinking about what steps I can take in my practice to promote our transition to this new paradigm and the ways that I can use it in my mentoring and teaching spread to tilt it toward becoming the prevailing paradigm.

If you were a part of the workshop, I’d love to get some comments on what you thought.  If you weren’t there, I encourage you to check out the information in their handout and in the abstract.  Check out that page here.