Concept Map for Medical & Mental Health Interpreting Education

HolisticWheel

St. Catherine University – CATIE Center; NURIEC; NCIEC.  2008
Karen Malcolm, Curriculum Consultant.  Laurie Swabey and Cathy Cogen, Project Directors.

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1: Orientation | 2: Conditions/Treatments | 3: Language Use | 4: Ethics/Boundaries | 5: Interpreting Skills | 6: Interpersonal Skills | 7: Self-Care/Self-Awareness | 8: Professional/Research Skills

Module One: Orientation/Overview of Mental Health/Medical Interpreting

This module provides an introduction to working in medical and mental health settings.  Students will be introduced to the settings where this work is performed and the systems and structures in place; to personnel involved in the provision of services; and to the characteristics of mental health/medical interpreting that are unique to these settings.

Content:

  • Deaf, deaf-blind, hard of hearing people and their experiences with the medical/mental health setting
  • Systems in mental health/medical settings
    • 7 main fields in medicine (surgery, internal medicine, family and community medicine, pediatrics, obstetrics and gynecology, emergency medicine, psychiatry)
    • Overview of health care system
    • Structures and hierarchies
    • Private insurance and HMOs
    • Acute vs. chronic:  Emergency room, long term care, residential programs, rehab, out patient
    • Mental health continuum from psychiatrically disturbed to people who are seeking self-growth/enlightenment
    • Teaching hospitals
    • Difference between public and private systems
  • Personnel
    • Roles, function and relationship (e.g., case manager, doctor, psychiatrist, etc.)
    • Boundaries
  • Legal responsibility
    • HIPAA, duty-to-warn, legal privilege, informed consent, etc.
    • ADA, state human rights acts
    • Professional liability
    • Honest representation of credentials and training
  • Treatment protocols
    • Various health care approaches, e.g., Chinese medicine, ayurvedic, etc.
    • Policies, goals, dynamics, interventions, procedures
  • Role of interpreters in these settings
    • Ability to explain role/function without use of jargon
    • Staff vs. freelance
    • Boundaries
      • working with people with borderline personality disorders
  • Advance directives and living wills
  • Challenges and Rewards
  • Multicultural, multi-ethnic perspectives

Resources:

  • Virtual hospital tours
  • DeMatteo, A.J., Veltri, D. and S.M. Lee. (1986). The role of a sign language interpreter in psychotherapy.  In M.L. McIntire (Ed.). Interpreting:  The Art of Cross-Cultural Mediation.  Silver Spring:  RID Publications. 135-153
  • RID Standard Practice Papers (Medical, Mental Health)
  • Taber’s encyclopedic medical dictionary

Teaching Approaches:

  1. observation, live and/or virtual tours
  2. readings
  3. structured discussion groups
  4. guest commentaries
  5. independent exploration
  6. demand/control

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Module Two: Conditions and Treatments

Students will become familiar with common conditions, procedures and treatments that present in medical and mental health settings.

Content:

Medical

  • Common conditions
  • Medical etiologies and syndromes, and impact on communication
    • Developmental disabilities, Usher syndrome, etc.
  • Anatomy and physiology
  • Treatments
  • Medication instructions
    • Medications and their impact on language and behavior
  • Procedures
    • common diagnostic procedures, e.g., X-Ray, CT scan, MRI, EKG, lab tests, endoscopies/colonoscopies, mammograms, PSAs, Pap smears, etc.

Mental Health

  • Common conditions
  • Medical etiologies and syndromes, and impact on communication
    • Developmental disabilities, Usher’s syndrome, anxiety disorders, DSM IV conditions, etc.
  • Abnormal psychology and diagnoses.
  • Intro to psychotherapeutic approaches
    • Cognitive Behavioral Therapy, EMDR, Family Systems Therapy, etc.
    • Role of the therapeutic alliance
  • Treatments
    • Medication instructions
    • Medications and their impact on language and behavior
  • Childhood trauma and sexual abuse
  • Substance abuse
    • 12 step programs, detox, relapse prevention, etc.
  • Common forensic mental health areas
    • Eg, NGRI, competency to stand trial, etc
  • Diagnoses  DSM IV

Resources:

Teaching Approaches:

  1. readings and structured discussion
  2. lecture
  3. modeling/mentoring
  4. observation
  5. demand/control

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Module Three: Language Use in Mental Health/Medical Settings

Continuing to build on content learned in the previous module, students will consider the specific vocabulary and discourse used in medical and mental health discussions.

Content:

  • Vocabulary, both English and ASL

Medical

  • Medical  instructions
  • Discourse ( including the ways in which medical professionals talk to patients and family members)
  • Medical terminology
  • Sociolinguistic variation (age, gender, race, sexual orientation, SES, etc.)
    • Register
    • Politeness
  • Dysfluency
  • Assessments
  • Sight translation

Mental Health

  • Discourse (including deliberate ways in which mental health professionals talk to clients and family members)
    • assessing clients at risk of harming self and/or others
  • Sociolinguistic variation
  • Conveying level of nuance and feeling state
  • Emotionally charged language
  • Dysfluency
    • abnormal language features (e.g., rapid speech, rapid subject changes, etc.)
  • Assessments
    • Psychological tests
    • Mental status exam
    • Psychiatric tests
  • Sight translation

 

Resources:

  • www.deafdoc.org  Definitions of common conditions, presented in ASL
  • www.medicalinterpreting.org Videos in ASL describing common conditions
  • Sign Media, Inc.  AIDS: Overview and Prevention. Simultaneous lecture
  • My Body, My Responsibility: A Health Education Video for Deaf Women.  Deaf Wellness Center
  • 2 Dialectical Behavior Therapy Videos:
    • Opposite Action: An Adaptation from the Deaf Perspective, and
    • Practicing Radical Acceptance: An Adaptation from the Deaf Perspective.  Deaf Wellness Center
  • St. Catherine University DVDs:
    • When the Law Meets Medicine.
    • Stomach This: the Digestive System in ASL and English
    • To the Heart of the Matter: the Cardiovascular System in American Sign Language and English
    • Birth Companions: Perspectives on Doulas and Midwives in ASL and English
    • All in Due Time: Perspectives on Childbirth from Deaf Parents
  • Howard, N., K. Malcolm and D. Still. (1999).Interpreting in a Medical Setting. Four videos including a range of Deaf people talking about personal medical experiences such as treating a skin condition, pregnancy and delivery, diabetes, HIV/AIDS, etc.

Teaching Approaches:

  1. readings and structured discussion
  2. lecture
  3. modeling/mentoring
  4. guest commentaries
  5. independent exploration

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Module Four: Ethics and Boundaries

Students will explore the ethical challenges that arise in medical and mental health settings, and consider how ethical codes are applied.

Content:

  • Values clarification
    • how might our values affect an interpretation
  • Decision making tools and skills
  • Morals and laws
  • Respect for consumers’ autonomy
  • Conflict of interest
  • Advocacy
    • When/how/who to share knowledge/evidence of possible language dysfluency
    • Referring to outside help/resources
    • Clarify assumptions re typical ASL behaviors (eg, eye gaze, facial affect)
    • Intervention to prevent serious harm (eg., if serious allergy has been overlooked, client talking about harming self or others)
  • Education re role
    • Discuss impact of interpreter on group dynamics
    • Gender issues and client preferences
    • Provide input to Deaf, deaf-blind, hard of hearing communities
    • Working as a mentor with other interpreters
  • Confidentiality
    • Supervision and professional conferencing
  • Staff vs. freelance
  • Cultural mediation
  • Boundaries
  • Transference and counter-transference

Resources:

  • www.vch.ca/wbp/Docs/Psychotherapy_with_Deaf_Clients_2001.pdf
  • Gish, S. and M. Barnum. Ethics and Decision-Making for Interpreters in Health Care Settings.
  • Mills Stewart, K. and Witter-Merithew, A. The Dimensions of Ethical Decision-Making: A Guided Exploration for Interpreters. 2006 . Sign Media, Inc.: Burtonsville, MD.
  • Gordon, P. and M. Magler. (2008). The Mentor’s Companion. RID Publications.

Teaching Approaches:

  1. case studies and discussion groups
  2. readings
  3. guided discussion groups
  4. guest commentaries
  5. role plays

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Module Five: Interpreting Skills

Students will practice the delivery of equivalent messages in medical and mental health settings. They will consider the reasons for using CI and SI, determine when each is appropriate, and practice employing each effectively in these settings.

Content:

  • Preparing for the assignment
  • Management of interaction (e.g., requesting clarification, asking a speaker to pause, etc.)
  • Consecutive skills
  • Simultaneous skills
  • Appropriate decisions re use of CI/SI
  • Conveying meaning
  • Di and hearing interpreter teams

Medical

  • Interpreting pain levels
    Use of classifiers and SASSes

Mental Health

  • Conveying metaphoric meaning
  • Awareness of impact of linguistic choices on therapeutic message
  • Interpret extra-linguistic nuances of therapeutic communication

Resources:

  • www.medicalinterpreting.org – College of St. Catherine’s DVDs:
    • Internal Discussions: An Appointment in Cardiology
    • Internal Discussions: An Appointment in Gastroenterology
    • Hurry Up and Wait: Interpreting a Visit to an Emergency Department
    • Take These Meds: Interpreting Visits to a Pharmacy
  • Treehouse Video: Interpreting in Mental Health Settings.
  • Howard, N., K. Malcolm and D. Still. (1999) Interpreting in a Medical Setting.  A set of four videos including scenarios for consecutive interpreting practice with Deaf people in a range of medical settings, conversing with actual doctors and nurses.  Scenario topics include migraine, back pain, diabetes, abdominal pain, and others.
  • www.asl_interpreting.tripod.com Interpreting for AA Meetings

Teaching Approaches:

  1. lecture
  2. small group practice
  3. video samples
  4. observation/supervision
  5. mentoring
  6. guest commentaries

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Module Six: Interpersonal Skills

Students will practice interpersonal skills pertinent to mental health/medical settings, and learn to effectively negotiate relationships with others involved in these settings.

Content:

  • Listening and observation skills
  • Problem solving skills
  • Teamwork
  • -working with spoken language interpreters
  • Professional Etiquette
  • Assertiveness
  • DI and hearing interpreter teams

Mental Health

  • Forming therapeutic alliance with therapist and all providers:
    • Pre- and post-sessions
    • Negotiating during therapy session
    • How and when to seek clarification or interrupt or not

Resources:

  • Pollard, R., 1998. Mental Health Interpreting:  A Mentored Curriculum.Rochester, New York: University of Rochester. (manual and videotape)

Teaching Approaches:

  1. readings and structured discussion
  2. mentoring
  3. case studies
  4. role play
  5. observation/supervision

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Module Seven:Self-Care and Self-Awareness

This module addresses the importance of self-awareness and self-care, and
prepares students to manage their physical and emotional selves while providing mental health/medical interpreting.

Content:

  • Personal safety
  • Vaccinations
  • Universal precautions, including knowledge of isolation procedures
  • Environmental awareness (e.g., X-Ray)
  • Physical and emotional stamina
  • Awareness of own issues and their potential to affect the interpretation
  • Exploring and managing personal reactions and knowing personal limits
    • Developing somatic awareness and philosophy of detachment
    • Reactions to smells, sights and sounds
    • Both inside and outside of interpreting setting
  • Vicarious trauma
  • Strategies for self-care

Resources:

  • Harvey, Michael. Shielding Yourself from the Perils of Empathy, and The Hazards of Empathy: Vicarious Trauma of Interpreters for the Deaf  www.michaelharvey-phd.com
  • Harvey, M. (2001). Vicarious Emotional Trauma of Interpreters: A Clinical Psychologist’s Perspective. In Journal of Interpretation, 85-98.

Teaching Approaches:

  1. lecture
  2. case studies
  3. mentoring
  4. field research/independent exploration

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Module Eight: Professional and Research Skills

This final module guides students into identifying and evaluating research in the field, and applying this to their professional practice. It also fosters the development of a professional identity as a specialist in the area of interpreting in mental health/medical
settings.

Content:

  • Awareness of current interpreting standards
  • Awareness of current health care and mental health practices
  • Legal issues in medical and mental health settings
  • Professional liability insurance
  • Establishment and implementation of annual professional development plans
  • Use of technology to access information
  • Familiarity with research in field
  • Ability to evaluate and apply research to professional practice
  • Commitment to life-long learning
    • Establishing avenues for supervision, debriefing, mentorship, collegial support and consultation

Resources:

  • Angellini, C. (2002). The visible co-participant: The interpreter’s role in doctor-patient encounters.  In Metzger, M., S. Collins, V. Dively, and R. Shaw, Eds. From topic boundaries to omission: New research on interpretation. Gallaudet University Press: Washington, D.C.
  • Metzger,M. (1999). Sign language interpreting: Deconstructing the myth of neutrality. Washington, DC: Gallaudet University Press.
  • RID Standard Practice papers
  • www.futurehealth.ucsf.edu/pewcomm/html

Teaching Approaches:

  1. lecture
  2. guided readings and discussion groups
  3. mentoring
  4. guest commentaries

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St. Catherine University – CATIE Center; NURIEC; NCIEC.  2008
Karen Malcolm, Curriculum Consultant.  Laurie Swabey and Cathy Cogen, Project Directors.