Interviews with Mental Health Interpreter Educators
NCIEC Mental Healthcare and Substance Abuse Interpreting Work Team1
Introduction | Section I: Analysis | General Recommendations | Training Components | Training Delivery Modes | Interview Summaries | Izabel Arocha | Robyn Dean | Charlene Crump | Karen Malcolm | Greta Knigga & Barbara Dunaway | Arlyn Anderson | Dan Veltri | Interview Guide | Resource Identified by Interviewees | Resources Provided by Interviewees
The National Consortium of Interpreter Education Centers (NCIEC) was charged, among other priorities, with identifying and establishing effective practices in a number of interpreter work settings, including interpreting in mental health settings. The Consortium members chartered the NCIEC Mental Healthcare Interpreting work team to lead that effort. During 2006-2007, the work team, led by Cathy Cogen, Director of the Regional Interpreter Education Center at Northeastern University, obtained the input of a wide range of content experts in the field, completed a review of the literature, and developed domains and competencies for interpreters working in these settings.
Upon completion of those activities, the work team determined additional input was needed from program administrators and educators in the area of mental health interpreting education. To gather that input, the work team contracted with an external consultant, Karen Dahms. The NCIEC work team leader had identified eight administrators and/or educators who offered instructional programs or media for signed or spoken language interpreters. The interviews conducted in the latter part of 2007 and reported on in February 2008 included the following individuals:
Cambridge College Mental Health Interpreting Certificate Program
Cambridge Health Alliance Mental Health Lecture Series for Medical Interpreters?
Mental Health Interpreting Consultant/Coach?Instructor for CATIE Mental Health Workshop
Developed New Mexico Mentoring Curriculum
University of Rochester Medical Center?Observation-Supervision in MH Interpreter Training project and study of effectiveness
Interpreting in Mental Health Settings Workshop
Vancouver, British Columbia
Health and Well-being Program
Interpreting in Mental Health Settings
?This report provides an analysis of findings of the interview sessions and a summary of each interview. The findings are useful in identifying those competencies, teaching approaches, and resources considered critical to effectively prepare interpreters for work in mental health settings. The findings lend further support to the Mental Healthcare Interpreting Domains and Competencies established by the work team in 2007. The information gathered through the interview process is organized in two primary sections of the report:
- Section I – Analysis of the information collected, organized into broad findings.
- Section II – Summary of each interview. (Each interview summary has been approved by the interviewee.
Because of the variation among the roles and responsibilities of the eight individuals interviewed and the training and education programs they are responsible for, there was corresponding variation in the type of information reported. Therefore, a summary of each interview and the information collected is provided in Section II of this report. However, there were also many areas of agreement among the interview participants, and a number of common patterns and trends emerged over the course of the interview process. Based on a final analysis of the information collected, it has been organized into the following broad categories of findings and recommendations:
- Mental Health Interpreting Education and Training Components
- Mental Health Interpreting Education and Training Delivery Modes
Finding 1 – Need for a National Resource Site
It was interesting to learn that at the time of the interviews, the interviewees were largely unaware of other programs offering specialized training in this area. While each of the participants was extremely knowledgeable with regard to the subject matter of interpreting in mental health settings, they were far less aware of other resources that might be available. Several interviewees inquired about other professionals participating in the interview process, but upon being informed of those participants, were for the most part unfamiliar with either the individual or program. The one exception was the Dean/Pollard Observation and Supervision research project, which was recognized and identified by most as innovative and effective.
In addition, several interviewees indicated the need for materials to be developed that were identified by other programs as already existing. For example, two programs spoke to the need for a DVD of actual Deaf mental health patients in a therapeutic session as a training tool, while two other programs identified such a DVD as already existing and in use in their programs. All of the individuals interviewed were excited about the prospect of a resource site on the subject of mental health interpreting, as envisioned by the NCIEC. All expressed interest in either participating in or being linked through such a site.
Finding 2 – Shortage of Qualified Mental Health Interpreters
It was no surprise that several of the interviewees indicated that their programs had sprung from a ‘local’ awareness of a shortage of qualified interpreters available and trained to work in mental health settings. As an example, two program interviewees indicated issues related to the shortage of qualified mental health interpreters were raised by mental health providers in their state as a critical issue. For those programs, members of the mental health professional community played an active role in developing training and curriculum to address the need. It was also interesting to note that many of the individuals seeking education from the programs participating in the interview process already possessed some experience interpreting in mental health settings. Based on the interviews, it would appear that these interpreters, having encountered the complexities associated with working in mental health settings, were seeking additional education, training, tools and techniques to be more effective.
Finding 3 – Interpreter Roles and Responsibilities
Interviewees stressed repeatedly that interpreting in mental health settings was entirely unique, and therefore required its own set of clearly defined interpreter roles and responsibilities. Further, several of the interviewees indicated they had gathered information or directly received feedback from providers and Deaf consumers that interpreter roles and responsibilities, and hence performance, vary widely in mental health settings. While these interviewees stated the need for clearly defined roles and responsibilities and more standardized norms for interpreter behavior in the mental health setting, the extent to which their program addressed the issue was less clear. When further questioned, some specific examples of educational components designed to reinforce appropriate roles and responsibilities were provided. Those components identified included the following:
- Roles and responsibilities related to the interpreter’s participation in the provider/interpreter/patient triad;
- Establishing and maintaining communication and rapport with the mental health provider;
- Participating as a member of the treatment team versus patient advocate;
- Managing personal issues and reactions within the therapeutic session;
- Serving as a resource to the provider on issues related to deafness; and
- Adhering to applicable legal and ethical mandates and policies related to mental health settings and interpreting in those settings.
Finding 4 – Program Participants
Overall, the programs that participated in the interviews were geared toward experienced interpreters already working in the field, and to a significant extent, interpreters that had some experience interpreting in mental health settings. Those programs that indicated they permitted novice interpreters to enroll in their education and training reported less satisfactory outcomes on the part of these inexperienced participants. In fact, two programs identified that having novice interpreters enrolled in their program ultimately detracted from being able to spend the time necessary with the more experienced program participants. Further, having novice participants required two levels of instruction and was a deterrent from accomplishing the educational goals of the session, particularly with regard to discussions and debriefings centered on case studies and interpreting experiences.
In addition, three of the programs interviewed had designed their education and training programs to include both working interpreters and working mental health providers. These programs felt involving both types of professionals in the training greatly assisted in addressing the issues that arose between the two professions when working together in the mental health setting, and helped to establish a common ground and imparting techniques for building the interpreter/provider understanding and relationship. Those programs indicated that participation of both professional groups contributed to positive program outcomes; however this assumption appears to be largely anecdotal.
Finding 5 – Mental Health Culture and Settings
Each of the programs interviewed spent some portion of time educating participants about mental health culture and the array of mental health settings interpreters may find themselves working in. About half of the programs provided general awareness regarding mental health culture and the range of mental health sub-settings, including geriatric, family counseling, group sessions, substance abuse, trauma, crisis intervention, in-patient versus out-patient, residential treatment, substance abuse, rehabilitation, etc.
Other programs appeared to spend significantly more time on the topic of mental health culture and settings. A few included requirements for participants to complete practicum hours across a number of mental health sub-settings, and/or opportunities for participants to observe treatment scenarios across a range of mental health settings involving Deaf mental health patients and providers. These programs also included additional, highly specific, educational components, such as understanding the role and function of the various members of the mental health provider team, from therapist to technician, and information related to the use of standard mental health testing and assessment tools, and the challenges encountered when these tools are used with Deaf mental health patients.
Finding 6 – The DSM and Mental Health Diagnosis and Treatment
Information related to the Diagnostic Statistical Manual (DSM) and mental health diagnoses and treatment were covered by all of the programs participating in the sessions, however to greatly varying degrees. About half of the programs placed heavy emphasis on imparting a comprehensive understanding of the DSM and mental health terminology; diagnoses and diagnostic assessments; therapeutic approaches, and a range of treatment scenarios and protocols. Those programs were of the mindset that if the interpreter did not have an in-depth understanding of different diagnoses and therapeutic approaches, they would never truly grasp and understand the intention of the session, and subsequently would not be effective working in the mental health setting. In fact, they could actually be a detriment to the attainment of the therapeutic goals for the Deaf patient. To that end, their programs were designed with the goal of providing participants with a sound framework for understanding and participating in the type of discourse that occurs in relation to mental health diagnosis and treatment. For example, significant attention was paid to specific psychological disorders and their implications with regard to communication and interpreting.
Other programs focused on imparting a more general awareness or introduction to the DSM and mental health diagnoses and treatment. Two of the interviewees actually cautioned against spending too much time on the DSM and mental health diagnoses and treatment scenarios, noting it is important that interpreters understand what the DSM is, and how to access it as a resource, but stressing it was not their program’s goal to prepare the interpreter to function as a mental health clinician or therapist.
Finding 7 – Interpreter Practitioner and Mental Health Provider Partnership
All interviewees placed importance on the unique type of partnership, or rapport, established between the interpreter working in the mental health settings and the mental health provider. It was repeatedly stressed that in no other setting was this type of relationship building so critical than the mental health setting. The prevailing view was that the interpreter must work as part of the provider treatment team, not simply as the voice or advocate of the Deaf patient, and that to be successful, the interpreter must meet the needs of the mental health provider as well as the mental health patient.
More than half of the interviewees indicated they spent a significant portion of their training and education on the topic of interpreter/provider communication and partnership. Those programs explored and discussed provider goals for various patients, settings and sub-settings, and provided tools and techniques for building effective communication between the two professions, for example, pre- and post-assessment sessions in which the interpreter observes, and to a degree, participates in provider diagnosis and treatment discussions. The objective was to give the interpreter insight and tools they can utilize to understand the goals of the mental health provider and how to pursue those goals effectively. To that end, a great deal of focus was placed on the interpreter’s potential impact on the therapeutic process, provider/patient relationship, and overall session outcome. Overall, the interviewees agreed that the provider must maintain the dominant relationship with the patient, and cautioned that if the patient comes to rely on the interpreter more than the provider, it can adversely affect the therapeutic outcome of the session.
Several of the programs offered student participants opportunities to be involved in mental health provider/clinician meetings. They considered this an important aspect of the education as it allowed the interpreter to better understand provider ‘thought worlds’ and the rationale and science behind the diagnosis and planned treatment of the patient. Several interviewees also stressed that education and training must address the needs of the mental health provider with regard to understanding deafness and the role and responsibilities of the interpreter. Those programs believed the interpreter should be prepared and equipped to initiate discussion and provide information on research and resources to the clinician inexperienced with deafness; this was also recognized as an often uncomfortable role for the interpreter.
In spite of the agreed upon importance of the interpreter/provider relationship, several interviewees, including those that has committed to involving mental health providers in program and curriculum design, reported they have encountered resistance on the part of mental health providers regarding the role and responsibilities of the interpreter, and have not always been successful in bringing the two professions together. They have found that some clinicians, hearing and Deaf, were so accustomed to working alone with the patient, that they were uncomfortable bringing a third person into the intimacy of the diagnosis and treatment session.
When asked to recommend optimal components of training and education for mental health interpreting, all eight interviewees recommended substantial time be allocated to address issues related to building interpreter/provider rapport and understanding.
Finding 8 – Provider/Patient/Interpreter Triad
Several interviewees raised the issue of education and training related to the provider/patient/interpreter triadic relationship. They believed the interpreter needs to have a relationship with the provider and the patient, but must also understand boundary setting and how to establish the appropriate professional distance, especially from the patient, who might tend to bond with the interpreter because of cultural bonding factors. Interviewees also stressed that the interpreter needs to understand the role of the mental health provider, and the importance of supporting the rapport and relationship between provider and patient. The interpreter needs to understand the complexities of the provider/patient relationship, including the interpersonal communication between the patient and the provider and the interpreter’s role in managing that communication and relationship, which is largely psychological and nuanced from person-to-person and case-to-case. For example, the interpreter must understand issues related to transference and counter transference and how it affects interpretation; opportunities for consecutive interpreting versus simultaneous interpreting, or how specific linguistic choices might trigger reactions from the patient and the provider and affect participant reactions. The key objective to be achieved through education and training on this topic was to impart to the interpreter that when interpreting in mental health settings, they must ally themselves with the treatment process, not the Deaf client, which, again, is a different mindset than interpreting in other settings.
Finding 9 – Practicum Experience
Most interviewees stressed the importance of including a practicum component as part of education and training for interpreting in mental health settings. Approximately half of the programs included some aspect of a practicum; those that did not indicated if time and resources permitted, their program would include a practicum component. The programs that included a practicum component varied with regard to how that aspect of education was carried out. In two of the programs, students were provided opportunities for supervised practical application of previously studied theory and content material (based on the Dean Observation/Supervision approach). Another program required a 40 hour individualized practicum and completion of a comprehensive written exam based on the practicum experience to receive state certification. In that practicum, the participant was required to work with a mentor who met state and training program criteria; spend one week at the affiliated state psychiatric unit as part of an observation and supervision experience, and complete practicum hours across a range of mental health sub-settings, for example, outpatient therapy, day treatment, rehabilitation, or group home settings.
Several challenges were raised with regard to offering a practicum. One related to the availability of qualified mental health interpreter mentors or supervisors to oversee participants enrolled in the practicum. Another challenge raised by a few interviewees was access to the mental health settings and actual therapeutic sessions. This access could be problematic due to the intimacy of the setting and patient confidentiality issues. In addition, mental health administrators were often not very accessible or amenable to having an extra individual trailing the patient and provider.
Finding 10 – Observation-Supervision Approach
Each of the interviewees was aware of the Dean/Pollard Observation-Supervision approach. All interviewees viewed the approach as innovative and effective. Four of the program interviewees (including Dean) described their programs as including a substantive observation and supervision component, either strictly or loosely based on the Dean/Pollard project. In those programs the sequence of activities was basically the same. Participants were provided opportunities to observe mental health providers working with Deaf patients; observations of those sessions were recorded and used as the basis for follow-up discussions and debriefings with qualified and experienced supervisors and/or experienced mental health interpreter mentors. Two programs (including Dean’s) used the Demand-Control (DC) Schema as the basis for recording observations; the other programs used different tools and/or checklists. During the supervision sessions, the supervisor, or instructor, reviewed participant observations and led discussions related to those observations with the purpose of analyzing the consequences of the translation and behavioral decisions that might apply to an array of hypothetical Deaf consumers, in the context of the actual observation of hearing clinicians and hearing patients. The objective of all four programs was to emphasize the interpreter/provider relationship, and offer opportunities for interpreting practice and debriefing discussions focused on interpreting options and consequences, including how boundaries were set and how roles played out. The approach provided participants with a better understanding and insight to the goals, thought processes and treatment challenges that clinicians face.
Two additional programs offered participants less formalized opportunities for observing interactions in mental health settings and then discussing and debating what was observed. One was delivered through videotaped sessions of simulated provider/patient sessions followed by classroom discussion led by an experienced mental health interpreter/instructor. The other program included a role play component in which participants were assigned role of provider, interpreter or patient in a simulated therapy session. The role play was followed by breakout group sessions in which participants discussed their role and the behaviors and choices that were made during the simulation, and how choices made might affect the therapeutic outcome of a session.
Finding 11 – Interpreter Protection and Personal Growth
Most of the interviewees indicated that education and training for interpreting in mental health settings should be designed to assist the interpreter in understanding themselves, boundaries and sensitivities, and developing a mature, safety-first approach to interpreting in this complex, often highly-charged setting. Approximately half of the programs included some level of instruction in this regard. They noted that therapists and psychologists received this type of training, but it was typically unavailable to interpreters working in the setting. The interpreter serves as the voice for the patient, which in this setting can be an emotionally devastating position to be in. In this setting, interpreters need to be able to maintain professional distance and not internalize information; they need approaches for managing transference and counter transference, and they need education and techniques that allow them to work in the setting, process information, and then let it go. To that end, the purpose of this aspect of the educational process was to provide individuals working in the setting with avenues for discharging emotional intensity, and with strategies for self-awareness and self-care, or tools and techniques for ‘staying safe.’
Two programs recommended that interpreters that have actually once been a patient in a mental health setting would have an advantage interpreting in this setting. One program recommended that interpreters work with a therapist or coach to increase self-awareness and psychological mindedness, thereby helping prepare them for interpreting in mental health settings.
Finding 12 – Mentoring and Field Supervision
Because of the inherent uniqueness associated with interpreting in mental health settings (and each of the various sub-settings), there will always be situations arising that are new to the interpreter and which pose an array of complexities and challenges. Several interviewees stressed the need to provide those interpreters working in mental health settings with access to ongoing supervision and/or mentoring support. There are many gray areas associated with working in this setting where the input, supervision and feedback of an interpreter with substantive experience in mental health environments could serve as a critical sounding board to the working practitioner.
One interviewee had worked with the New Mexico Mentoring Program to design and develop a 16-week on-line mentoring curriculum. The need for the curriculum was driven by the fact that New Mexico is such a large, rural state, and that many of the interpreters working in mental health settings remotely located in the state, with little or no access to experienced supervisors or mental health interpreters. The curriculum was based on a 360 page workbook and delivered through readings in the workbook, on-line research activities and email communication with an assigned mentor. Each chapter of the workbook included readings and self-awareness activities designed to simultaneously expose interpreters to typical activities they might interpret in psychiatric settings and increase self-awareness. There were also on-going assignments and weekly activities to send to the mentor. About one third of the curriculum focused on mental health and mental illness. The second portion of the training focused on emotional nuance, considered a critical part of the training experience. The third portion of the curriculum simulated activities to practice incorporating emotional nuances into voicing and signing.
Another program assigned a mentor to program participants required to complete a comprehensive practicum to achieve state certification. The mentors had to also meet state and training program criteria. That program reported one of its challenges had been finding qualified mentors to serve in this capacity.
Finding 13 – Classroom Instruction
All of the programs interviewed included a component of classroom time. For some programs, that time was used to cover content information, such as the DSM and mental health diagnosis and treatment. Other programs stressed that training and education for work in this setting must include interactive opportunities for participants to discuss and debate choices, options and consequences with other participants under the guidance of experienced instructors – typically in a classroom setting. The four programs that implemented some aspect of the Dean/Pollard Observation–Supervision approach used the classroom setting as the forum for discussing and debriefing participants on the observation portion of the program. When asked to recommend optimal delivery mechanisms, nearly all interviewees indicated that some aspect of interactive classroom discussion and debriefing was necessary. Two programs actually cautioned against education and training that did not include some component of interactive classroom time.
Finding 14 – On-line Opportunities
Several interviewees identified on-line components of their program. These components varied widely and include: reading and research assignments to participants wherein they must use the internet to access the DSM or other relevant resource materials; interactive discussion forums; listservs among program participants, and e-mail to communicate and exchange information with an assigned mentor. However, for the most part, interviewees cautioned against on-line delivery for all aspects of education and training for interpreting in the mental health setting. As noted above, interactive classroom-based discussion and debate were considered by most a critical component of education and training for interpreting in this setting.
Finding 15 – DVDs and Videotapes
Many of the programs interviewed used DVDs or videos to support the instruction process. Those described by participants include:
- Videotape of a simulated, one-hour counseling session involving an interpreter, an experienced therapist and a volunteer Deaf patient. Program participants observed and discussed the session.
- A videotape that captures “Interviews with Therapists,” and portrays seven therapists expressing their interest in working more closely with the interpreter and their need to understand more about Deaf culture. It is intended to help convince the interpreters that therapists want this communication and relationship with the interpreter.
- Videotape of a Deaf consumer. Participants are charged with stopping the videotape at various points and providing interpretation. They also are required to tape themselves as they are watching the videotape to understand how their reactions manifest themselves on their face.
- Treehouse Productions Video, organized around seven separate vignettes, each presented by professional actors. The vignettes portray various scenarios related to interpreting in mental health settings, each of which is designed to highlight a number of issues that might arise in the mental health setting.
- Videotaped sessions between the mental health provider, experienced interpreter and Deaf patient. The tapes to stimulate discussion and debate in the classroom with program participants, who include working interpreters and working mental health providers.
- A DVD of a number of different Deaf, mental health patients during diagnoses and treatment sessions.
- A DVD simulating various interpreting situations using actors.
Individuals selected to participate in the interview sessions were identified by the NCIEC Mental Health Interpreting work team. An information interview guide was developed by the external consultant with input and final approval of the NCIEC work team leader. The eight individuals participating in the interviews were:
- Izabel Arocha, Cambridge College Mental Health Interpreting Certificate Program
- Robyn Dean, University of Rochester Medical Center
- Charlene Crump, Alabama Department of Mental Health and Mental Retardation, Office of Deaf Services
- Karen Malcolm, Vancouver Health and Well-being Program
- Greta Knigga, Wright State University, Mental Health and Deafness Program
- Barbara Dunaway, Wright State University, Mental Health and Deafness Program
- Arlyn Anderson, Mental Health Interpreting Consultant/Coach
- Dan Veltri, Treehouse Video Productions
Interviews lasted from one to two hours. Loosely following the interview guide, participants were asked to:
- Describe their education and/or training program;
- Identify challenges they have found in delivering their particular program;
- Describe the optimal components and sequence of education and training in this area; and
- Briefly discuss with the consultant next steps in the process. Summaries of each interview are presented below.
Cambridge College Mental Health Interpreting Certificate Program
Cambridge Health Alliance Mental Health Lecture Series for Medical Interpreters
The lecture series and certificate program evolved as a result of hospitals in the state expressing frustration with the availability and preparedness of mental health interpreters. Mental health providers from the Division of Mental Health at Cambridge raised the need and actively participated in the course curriculum development. It has not been hard to attract interpreters to either the course or lecture series because they already recognize they need specialized training to succeed as interpreters in mental health settings.
The Cambridge Health Alliance Mental Health Lecture Series for Medical Interpreters is carried out over a 10 week period – one evening a week for 3 ½ hours per evening. Most program participants are local, have a medical interpreting background; some had a mental health interpreting background.
The Cambridge College Mental Health Interpreting Certificate Program is a two course, six credit program, offered to graduates of the Medical Interpreting Training Program and/or to interpreters who are currently in professional practice. It is geared toward working interpreters; the majority of the class was comprised of spoken language interpreters. Participant prerequisites are documentation that the individual has been trained as a medical interpreter, or completed a comparable program. It is strongly recommended that interpreters seeking to take the course have at least two years of experience, but this has not been strictly followed. It has been learned that this prerequisite should be enforced as program outcomes have not been as successful for novice interpreters that have completed the course. For example, novice interpreters may have passed the written test and interpreting skills portion of the program. Where they are not as strong is in the case discussions, as they have no cases to bring forth, and cannot compare physical to mental encounters if they do not have this previous interpreting experience.
The program is delivered through classroom instruction with follow-up homework assignments. The overarching objective is to teach students how to meet the needs of both mental health patients and providers by becoming fluent in English, mental health terminology, and one other language. Students become familiar with the Diagnostic Statistical Manual (DSM), frequent and less common mental health diagnoses and treatment options, frequently prescribed psycho-pharmaceuticals, and appropriate modes of interpreting for the mental health patient. Both consecutive and simultaneous interpreting are addressed as well as clarification of the role of the mental health interpreter.
The first portion of the program places emphasis on the issue of vocabulary and understanding of the DSM. Participants have to present on different diagnoses and demonstrate what they have learned with regard to mental health discourse. They are assessed on the type of vocabulary and thinking they used during their discourse/presentation, including how they described patient demographics and secondary symptoms. The objective is to teach participants how to speak the way providers speak in this setting and become comfortable with mental health provider discourse. They are tested on vocabulary as well as understanding of subject matter. The second portion of the program focuses on interpreting in mental health settings. The goal is to teach participants that mental health settings are unique, and to be successful interpreting in these settings, the interpreter must learn how to integrate themselves into the mental health culture. Participants must also understand that mental health is more than just one setting. For example, in Arocha’s institution, there are nine different mental health divisions including geriatric, adolescent, substance abuse, family counseling, outpatient, lockdown, etc. Each setting is unique and presents its own set of issues and challenges. The interpreter needs to understand each of the various sub-settings and the issues and interactions that might arise in each (for example, family meetings, use of patient restraints, safety issues, etc.). The interpreter also needs to understand their unique role in the mental health setting – that they are a team member with the mental health providers – not an outsider. This is a complex issue – that the interpreter is part of the treatment team and not the patient advocate. To that end, the course is designed to provide participants with a good understanding of mental health culture and a framework for understanding and participating in the type of discourse that occurs related to diagnosis and treatment, etc. The interpreter needs to understand the provider/patient relationship and have the necessary skills to understand issues of transference going on between the two and how to interpret communication appropriately. Arocha referred to the Dean/Pollard DC schema and the need for the interpreter to understand there is much more going on in a mental health setting that affects communication than in other settings, including medical settings.
The third component of the program assists participants in putting what they have learned into practice. This portion of the program includes opportunities for role play and debriefing, which helps participants internalize and vocalize some of the difficulties they can expect to encounter working in the mental health setting.
It has been difficult to strike the right balance between course objectives, namely, learning about the DSM and the different diagnoses; understanding the unique challenges related to working in a mental health setting, including the dynamic between the patient and provider, and putting what is learned in each of the above two into practice. Because of the large amount of material that gets covered in the first two categories of instruction, the practice aspect is largely sacrificed, yet is considered a critical part of the learning experience.
They could not have a practicum as part of the course; it would have been too hard to have a fourth party trailing the provider and consumer because of the intimacy of the setting and therapeutic process. However, because of the uniqueness of the setting, the practicum is particularly important. They have not really been able to solve this issue, other then to informally support mentoring in their institution so that the interpreter/participant has the opportunity to debrief and receive feedback from an experienced mental health interpreter.
The course did attract some novice participants, who lacking prior experience working in either medical or mental health settings, were not as successful in the program as participants with that experience. They did not collect this information – but sense this to be true. Having both types of participants enrolled in the program was not optimal – each took time away from the other. For example, novice interpreters were not able to effectively contribute to case-studies or rich discussions about actual patient-provider-interpreter triadic relationship building.
Because the program is tied to an educational institution, they are required to follow certain delivery guidelines – hence the night classroom structure. However, Arocha believes it would be optimal to offer the program through a combination of classroom instruction and fieldwork. The difficulty is that mental health settings in the field are often not very accessible or amenable to having an extra individual trailing the patient and provider. While the program offers opportunity for role playing, Arocha believes it is not as beneficial as viewing real patients and providers discoursing in the field would be.
Recommended Components of Training and Education
The Cambridge program incorporated aspects of all three of its course objectives into every classroom session: 1) understanding the DSM and different mental health diagnoses; 2) interpreting in mental health settings and sub-settings and the relationship between the provider, patient and the interpreter, and 3) practicing what was learned in the other two. Arocha believes this has been an effective way of delivering the material.
Arocha identified the Dean/Pollard Observation – Supervision approach as beneficial in the way it matches mental health interpreter students with the mental health provider. She suggests that an optimal part of any training and education for work in this setting should emphasize the interpreter/provider relationship and offer numerous opportunities for practice and debriefing. For example, it should cover how boundaries were set, how roles played out, and offer opportunities for both the interpreter participant, interpreter instructor and the mental health provider to debrief, identify options, and discuss the various consequences of those options.
While the practice in a real-life mental health setting is optimal, it needs to be done carefully. There needs to be a clear understanding of roles between the provider and the interpreter so that the patient does not end up looking to the interpreter as a provider. The provider needs to maintain the dominant relationship with the patient. If the patient comes to rely on the interpreter more than the provider it can set back the entire therapeutic outcome. The interpreter needs to have a relationship with the provider and the patient, but also understand boundary setting and how to establish the appropriate professional distance, especially from the patient, who tends to bond with the interpreter because of cultural bonding factors.
Development of training and education for interpreting in this setting should seek to involve mental health providers in curriculum development. At Cambridge, the psychology director and psychology residents alike were extremely cooperative and excited about developing the curriculum. They were as interested in learning about the interpreter perspective as the interpreters were to learn about the clinician’s perspective. In fact, at Cambridge, the psychology director expressed interest in co-teaching the course (this has not happened).
Learning about the DSM and different mental health diagnoses is critical. The goal is not to memorize the entire manual, but to be familiar enough with it that the interpreter can turn to it as a resource, and can understand the discourse that occurs on the part of the provider with regard to diagnoses and treatment. Possibly aspects of the DSM could be taught on-line. The student participants might be assigned particular excerpts of the manual and then practice discourse related to that excerpt in the classroom.
Arocha cautions against an entirely on-line curriculum. Feels there are aspects that can be delivered remotely, for example the DSM and information regarding mental health settings and sub-settings. However, Arocha maintains the dynamic role playing, feedback and debriefing should be done in a classroom and involve to the extent possible providers and experienced interpreters who have worked in the setting.
Training and education should include an overview/introduction to some of the basic documentation requirements of some of the major regulatory bodies, like the joint commission. This is important information to know when the provider is documenting ‘language access’ in the patient record.
Demand-Control Schema for Interpreting Work
Observation-Supervision in Mental Health InterpreterTraining
Prior to the interview, Dean provided the consultant with a number of background materials on the Demand-Control Schema and Observation-Supervision methodologies. These materials served as the springboard for the interview discussions. In fact, they were referred to throughout the interview process. Because of the complexity and level of detail associated with the Dean approach and project, rather than re-characterize the interview notes to create yet another version of descriptions of both, the formal published descriptions of the Demand-Control Schema for Interpreting Work, and the Interpreter Training Project (which is centered on testing the Observation-Supervision approach), are provided below. Following those two descriptions is a section entitled Interview Notes, in which the consultant recorded other information that was obtained during the interview with Dean.
The description of the Demand-Control Schema for Interpreting Work provided below was pulled verbatim from the University of Rochester, Deaf Wellness Center website.
Dean and Pollard (2001) adapted the D-C concept from occupational research conducted by Robert Karasek (1979) and Törres Theorell (Karasek & Theorell, 1990). Karasek and Theorell recognized that occupational stress and illness, or work satisfaction and effectiveness, arise from an interactive dynamic between the challenges ( demands ) presented by work tasks in relation to the resources (controls or decision latitude ) that workers bring to bear in response to job demands. This interactive view of work challenges and worker resources was a rejection of more static views of occupational stress as a function of specific job types. For example, while the occupations of firefighter, teacher, or physician are commonly viewed as high-stress, occupational research such as Karasek’s documented that such professions were not associated with high rates of stress-related illness if workers had adequate resources (e.g., education, experience, equipment and materials, emotional support, and flexibility in decision-making) to perform well in light of job demands. In contrast, when workers were least able to respond to high-demand job situations, (i.e., when they had few controls), stress-related illnesses were at their highest levels.
Dean and Pollard (2001) used the framework of D-C theory to examine the nature of demands and controls in the interpreting profession specifically. They defined four categories of job demands that act upon interpreters: environmental demands, interpersonal demands, paralinguistic demands (formally referred to as linguistic demands), and intrapersonal demands. Environmental demands are interpreting challenges or success requirements that pertain to the assignment setting (e.g., the need to understand consumers’ occupational roles and specialized terminology specific to a given setting or tolerance of space limitations, odors, extreme temperatures, or adverse weather). Interpersonal demands are interpreting challenges or success requirements that pertain to the interaction of the consumers (e.g., the need to understand and mediate cultural differences, power differences and dynamics, differences in fund of information (Pollard, 1998), or the unique perceptions, preconceptions, and interactional goals of the consumers.) Paralinguistic demands are interpreting challenges or success requirements that pertain to overt aspects of the expressive communication of Deaf and hearing consumers, i.e., the clarity of the –raw material” the interpreter sees and hears. Examples of paralinguistic demands are when a hearing individual has a heavy accent or is mumbling or when a Deaf individual is signing lazily, lying down, or has an object in his or her hands. Finally, intrapersonal demands are interpreting challenges or success requirements that pertain to the internal physiological or psychological state of the interpreter (e.g., the need to tolerate hunger, pain, fatigue, or distracting thoughts or feelings.)
In Dean and Pollard’s D-C schema, controls are skills, decisions, or other resources that an interpreter may bring to bear in response to the demands presented by a given work assignment. Controls for interpreters may include education, experience, preparation for an assignment, behavioral actions or interventions, particular translation decisions, (e.g., specific word or sign choices or explanatory comments to consumers), encouraging –self-talk,” or the simple yet powerful act of consciously acknowledging the presence and significance of a given demand and the impact it is having on an interpreting assignment. As adapted from Karasek’s D-C theory, the term controls refers to a broad array of worker characteristics, abilities, judgments, and actions that contribute to effective work. As we use the term, it is a noun, not a verb, and is preferably stated as control options. The term does not refer to –taking control,” –having control,” or “being in control” over demands that may arise. Control options may or may not be effective in meeting demands À in fact, the analysis of the effectiveness and consequences of how one chooses to respond (or not respond) to a given demand is the fundamental manner in which the D-C schema is applied during teaching, supervision, or self-analysis of interpreting work. Dean and Pollard define three temporal opportunities where controls may be employed: pre-assignment controls (e.g., education, language fluency, and assignment preparation), assignment controls (i.e., behavioral and translation decisions made during the assignment itself), and post-assignment controls (e.g., follow-up behaviors and continuing education). When engaging in a D-C work analysis, recognition of a given demand sparks consideration and critique of control options that might be employed during each of these three time periods.
The description of the Interpreter Training Project provided below was pulled verbatim from the University of Rochester, Deaf Wellness Center website.
The goal of the interpreter training project is to refine and evaluate the impact of an innovative training approach that will enhance the work effectiveness of mental health interpreters, thereby fostering more equitable outcomes in mental health care for Deaf and Deaf-blind consumers. An Objective Structured Clinical Exam (OSCE), a contextualized means of evaluating the performance and judgment skills of practice professionals, will also be refined and produced. The project will be led by co-investigator and project coordinator, Robyn Dean, CI/CT. The project methodology will be grounded in Dean and Pollard’s (2001) demand-control (D-C) schema for interpreting work and will incorporate the experience of the nations’ leading experts in the mental health interpreting field.
Our training program and OSCE development will spring from the successful methods already developed through our project Reforming Interpreter Education: A Practice-Profession Approach (Pollard & Dean, 2001), sponsored by the US Department of Education’s Fund for the Improvement of Post-Secondary Education (FIPSE) and conducted in collaboration with the University of Tennessee (see sunsite.utk.edu/cod/fipsedc). That project first immerses students in the D-C schema for interpreting work (Dean & Pollard, 2001). Subsequently, in courses on medical interpreting, post-secondary interpreting, and field work supervision, students engage in a process of D-C-based observations and supervision that is proving highly effective in accelerating student learning about translation and behavioral decisions – comparable to interpreters who have honed their skills over years of professional practice (Davis & Griffin, 2002; Dean, Davis, Dostal-Barnett, Graham, Hammond & Hinchey, in press).
In our FIPSE project, interpreter trainees first learn the D-C schema and then apply it through in-vivo observation activities in practice settings where there is no Deaf consumer or interpreter present , including a variety of medical settings and post-secondary educational environments. Unencumbered by interpreting responsibilities or blinded by a singular focus on sign vocabulary, this observation approach fosters student’s understanding of interpreting work factors that lie outside the strict bounds of language and culture. Often, it is these non-language, non-cultural factors that most influence translation and ethical decisions.
These additional factors exist in every interpreting work setting; they are what Dean and Pollard (2001) refer to as demands (in accordance with Karasek’s (1979) demand-control theory of occupational health and work effectiveness) . In order for interpreters to be effective in their work, the entire spectrum of assignment demands must be understood. Dean and Pollard identify four demand categories in interpreting work: environmental, interpersonal, paralinguistic, and intrapersonal demands. They also identify three opportunities to respond to work demands ² before, during, and after the assignment ² whether those responses include skills development, assignment preparation, specific translation decisions, attitude responses, or behavioral actions.
In our FIPSE project, students bring D-C-structured observation notes into 1:1 supervision sessions with experienced interpreter mentors. Group supervision (i.e., mentor-guided peer supervision) is also employed. In supervision, the language and cultural factors that were purposefully “removed” from the observation experiences are brought forward and interwoven with the environmental, interpersonal, paralinguistic, and intrapersonal demands the student has recorded, through discussions of hypothetical Deaf or Deafblind consumers who might have been in that situation. Discussions of interpreting for consumers are thus embedded in the students’ more thorough appreciation of the nature of the observed work settings and the typical goals and processes of hearing consumer dialogues and interactions in those settings. This fosters a greater comprehension of communication (and service) equity when considering the presence of Deaf, hard-of-hearing, or Deafblind consumers in such settings. It also allows considerations of multiple, alternative translation and behavioral decision with various types of consumers, which leads to broader, more generalizable learning. This contextualized approach to interpreter training is consistent with contemporary training methods in other practice professions, such as problem-based learning (PBL) in medical education (Frost, 1996.)
There are other benefits to this observation/supervision training approach. In our FIPSE project, students are developing comfort and enhanced professional and consumer respect in the presence of discussions of patients’ personal medical histories and physical examinations and procedures. They also are privy to the unique perspectives, communication goals, frustrations, practice challenges, ethical dilemmas, etc., of physicians. These insights foster the interpreters’ experience of themselves as fellow practice professionals. And through their application of the D-C schema to interpreting work, they see how their translation and behavioral decisions ² like physicians’ decisions ² are responses to complex demands of the job and, in turn, have a complex spectrum of consequences. Through the supervisory process, their dialogues with mentors and colleagues help them to assess, learn from, and refine those decisions ² again, just like all practice professionals do (Dean, et al., in press).
The proposed interpreter training project will begin with a meeting in Rochester, NY where four national experts will join Ms. Dean and Dr. Pollard to discuss and refine the proposed training methods, content, and research plan. Of the experts under consideration, most have already taken D-C schema workshops from Dean and Pollard and have begun incorporating its philosophies and methods in their interpreting work and teaching. After the panel’s consensus opinions have been incorporated into the research plan, the training project will be conducted in four urban settings with sizable Deaf populations as well as significant ethnic and language diversity within the local Deaf population: Rochester, NY (year 1), Minneapolis (year 1), New York City (year 2) and San Francisco (year 2). An expert interpreter mentor in each collaborating city has agreed to participate in the project: Mark Allan English in Minneapolis, Dan Veltri in San Francisco, and Jody Gill in New York City.
In each location, the project will span 5 months. Phase one involves D-C training for the expert mentor and any local collaborators, provided by Ms. Dean. This training will ensure that the collaborators have a thorough understanding of the schema and how it is specifically applied to the observation and supervision components of the trainees’ experience. Phase two involves the recruiting and training of a pool of 10 certified interpreters per site (see details below). Phase three involves the administration of an OSCE (described below), designed by the project team and adapted to the local circumstances of the prior training, to the 10 interpreter participants and a sample of 10 local interpreters who did not receive the D-C schema training. Subsequently and for the remainder of the project period, we will be tracking a number of post-training measures (see below).
The method of interpreter training used will parallel the observation/supervision approach described above and successfully employed during our FIPSE project. In this case, however, the observation environments will be a variety of mental health service settings. Only interpreters certified at the C.I./C.T. or C.S.C. levels by the RID or levels 3 ²5 by the NAD will be enrolled in the study. In each participating city, the expert mentors named above will be responsible for arranging site observations for their participants, utilizing their local contacts and resources. Each interpreter participant will complete 30 hours of observations over the course of 4 months in a variety of settings (inpatient, outpatient, emergency department, chemical dependency groups, etc.). To aid in their observation work, participants will use D-C observation sheets (modeled after those being used in our FIPSE project) that help them identify the salient issues in each situation and prepare for their later supervision sessions.
These interactions with mental health professionals in their work environment and “behind the scenes” – including the dialogues that will invariably occur between “patient events” – will yield important learning and professional development benefits for these interpreters, judging from similar results emerging from our FIPSE project. The interpreters will gain a much greater appreciation for the goals, thought processes, and treatment challenges that clinicians face. They will develop, and reflect back to the clinician, a greater appreciation for their own role as a fellow practice professional seeking a similar, collaborative goal of optimal patient care. These relationship benefits are fostered because the observing interpreter is not “in role” or consumed with a singular focus on language and sign choices and because the clinician, in this case, is not a consumer of interpreting services but a fellow practice professional.
While accruing these 30 hours of observations, participants will attend 2-hour group supervision sessions each week, led by the local expert mentor and attended by the other participants in the research cohort. Participants will receive continuing education units from the RID’s Certification Maintenance Program. Each of the expert mentors have been involved in mental health interpreter training on a national level. The content of these 2-hour supervision discussions will be driven by the events and issues described on the students’ D-C observation sheets but also informed and guided by the expert mentor’s own knowledge, pedagogical priorities in mental health interpreting, and teaching style. This approach is more effective than a proscriptive curriculum that a teacher is forced to adhere to and teach in a vacuum. As in PBL, our approach allows the contextualized nature of the problems confronted by the students (their identification of work demands in the four categories defined by Dean and Pollard) and the ensuing discussion of the hypothetical presence of Deaf, hard-of-hearing, and Deafblind consumers, to draw upon the mentor’s (and student peers’) knowledge and experiential resources in ways that non-contextualized, rote learning is unable to do effectively (including the typical mental health interpreting training modality of lectures or workshops.) The content that these expert mentors’ have previously discussed in lectures, workshops, and publications (e.g., Stansfield & Veltri, 1987; Veltri, 1993, 1997) is quite consistent with one another’s (and with Pollard, 1998b) and the collaborative meeting that takes place at the beginning of this project, and the continued oversight of the training by Ms. Dean, will assure that there is agreement and consistency regarding the major content themes, facts, and issues that we desire to impart over the course of the training period. Supplemented by some required readings, the supervision dialogues will be the primary vehicle through which content information is shared. This will not only contextualize the content, leading to better learning and retention, it will allow for the frequent reinforcing of content and promote generalization of learning as students encounter, identify, and discuss similar mental health issues repeatedly over the course of these 4 months.
Our practice profession approach to interpreter training seeks to enhance translation and behavior judgment, confidence, problem-solving skills, and self-evaluation abilities which cannot readily be assessed with existing language-focused interpreter evaluation tools. Fortunately, improvement in methods for assessing these more elusive but critical professional competencies have paralleled the evolution of PBL in medical schools. Among the more widely used approaches is the OSCE. OSCEs commonly involve simulated practice scenarios where students are evaluated on various performance skills (not just knowledge), including professional reasoning and behavior, which is gleaned from post-encounter interviews with students and trained OSCE actor-participants (Educating Future Physicians for Ontario, 1995). An interpreting-specific OSCE is being developed and piloted as part of our FIPSE project (Pollard & Dean, 2001). It is being designed in collaboration with our URMC faculty colleagues who have considerable experience in this evaluation method. Our OSCE will reflect the broader view of critical interpreter competencies we desire to impart through our D-C approach to interpreter training. Our OSCE is intended to set a precedent for the evaluation of interpreter competencies from a practice-profession perspective. This tool and approach should be of interest to ITPs as well as to states that are pursuing licensing regulations and any entity that employs sign language interpreters and seeks to document their competencies. A joint task force of RID and NAD is currently working toward development of a national interpreter examination to replace the current RID test. Leaders of this task force are in close contact with the DWC, monitoring our progress with the OSCE and our other innovations in interpreter training.
The proposed project will develop and employ an OSCE at each of the four sites conducting our D-C training. Local variations in the OSCE scenarios and content will be based on each locale’s characteristics in terms of Deaf consumers, mental health services available, and the training emphases that emerged over the 4 month training period. The OSCE will consist of practice scenarios that are depicted “live” by teachers and volunteers, on paper, and/or on videotape. Student performance is assessed through eliciting not only specific translation decisions but behavioral decisions (or lack thereof) and the reasoning behind them. Reasoning and actions relating to Dean & Pollard’s (2001) four demand categories and three opportunities to employ controls (pre-assignment, assignment, and post-assignment) also will be evaluated. The opinions of the aforementioned expert panel and the local expert interpreter mentors will determine the nature and range of optimal OSCE responses and scores. Again, a control group consisting of 10 similarly certified interpreters who were not part of the training cohort also will take the OSCE at each training site. (They will receive compensation for their time.) Clinical Research Coordinator and interpreter Susan Chapel will score all OSCEs. She will be unaware of the D-C training status of the participants.
Additional post-training measures will be obtained at 6-month intervals throughout the remainder of the project period. These measures will track the impact of the training on the actual work experiences of the trained interpreter cohort from each of the four training sites. These data will include the interpreters’ assessments of their work competencies, their frequency of use of D-C concepts and practices in their work, their ongoing assessment of the value of the specialized training they received, and the frequency of their work in various mental health service settings. Also, post-training data will be sought from the hearing and Deaf consumers for whom these interpreters work (via a request to participate in the feedback portion of the study that is written on a card the interpreter leaves with consumers; the card will direct consumers to a portion of the study website, where further information can be obtained and feedback questions answered on-line). Consumers will be asked to evaluate various aspects of the quality of the interpreters’ services and behavior as well as the impact that the interpreter’s services had on mental health service access and outcomes for the consumers. Consumers will be asked to complete the Client Satisfaction Questionnaire Mental Health Center (Larson, et al., 1979). These data will be collected and organized via the web-based data analysis application and report interface that will be used for all studies in this project (described in the Plan of Evaluation section of this narrative).
In year 3 of the project, the accumulated data (and experience) from conducting the interpreter training and administering the OSCEs at these four training sites, and tracking interpreter service outcomes subsequent to each site’s training, will be compiled and used to construct a final OSCE and a mental health interpreter training manual for national dissemination. For the final OSCE, we will hire Deaf, hard-of-hearing, Deafblind, and hearing individuals, including those from ethnic and language minority groups, to portray the most useful mental health service scenarios that emerged from conducting OSCEs at the four training sites. These scenarios will be digitally filmed by URMC audio-visual professionals. Other studies in this NIDRR project also employ digital filming to record actual mental health service delivery to Deaf, hard-of-hearing, and Deafblind individuals. These acted and actual film clips will be professionally edited and used to produce the final OSCE and training manual which will include relevant film clips and narration on CD (with open captions). The training manual and OSCE package will be completed in year 3 of this project, though data-tracking of our interpreter cohorts will continue through years 4 and 5.
Dean Interview Notes
Dean views interpreters as ‘practice professionals’ versus technical professionals. This is because the work dynamics and work environment are constantly changing.
The training project was designed for ‘student’ interpreters working in educational and medical settings (most of the participants are actually working interpreters that have returned for more in-depth and specialized education – maybe working toward a BA degree – so they are not purely students), although some are full-time students.
The Observation-Supervision approach is based on concepts of problem based learning (PBL), which is typically used in training medical students. It is based on a student-centered classroom, in which learning takes place in contextualized manner involving actual patient cases.
Participants in the Interpreter Training program must first have completed D-C Schema training.
Dean thinks it is critical to provide interpreter participants enrolled in the interpreter training program with insight into the ‘other side of the story’ – hearing professionals thought worlds. To that end, participants observe in specialized assignment settings with no Deaf consumer or working interpreter present.
Participants observe approximately 15 hours of mental health service provision between hearing clinicians and hearing patients; across variety of MH settings. Participants are also required to observe 1-2 hours in a number of other settings such as acute care, group therapy, family, child adolescent, etc.
Guided by a detailed mental health observation form, program participants document and analyze EIPI elements of observations. Observation forms submitted in advance of supervision sessions to site supervisor. After 8-10 hours of observation completed, supervision sessions begin – observation and supervision sessions overlap for remainder of course. During the supervision sessions, the instructor reviews the completed observation forms and uses them as the basis to facilitate student learning. They are discussed with regard to content and context. Specifically, both the controls that could be employed and the benefits and consequences of the various control options are discussed and debated. The purpose is to draw out and analyze the consequences of the translation and behavioral decisions that might apply to an array of hypothetical Deaf consumers, in the context of the actual observation of hearing clinicians and hearing patients. Testing occurs at the end of the observation-supervision sessions, is conducted through interviews, and is based on content as well as judgments made with regard to translation and behavioral decisions.
The four program instructors participating in the research program were taught to use the dialogue process versus the didactic teaching approach. It is also critical that the instructors of the Observation-Supervision approach be very familiar with the D-C schema as the process by which to make decisions. Instructors received this training prior to instructing in the program. They believe it is critical that the supervisor/instructor is able to effectively cover both the creative aspect of teaching as well as the didactic.
Dean/Pollard changed the last two test sites and modified some aspects of the training in order to better determine if it would be successful, effective and transportable across diverse settings.
Dean is aware that a number of IEPs are already teaching the D-C schema as part of the framework for interpreting, including interpreting in mental health settings. However, they do not collect information about these efforts and therefore do not know the extent of these teachings, the quality of the instruction, or the ultimate outcomes.
Dean has collected data on both content acquisition and the interview testing process to judge and test decisions related to translation and behavioral. See Dean’s article included in resource materials list. (Need link)
Recommended Training and Education
Dean recommends that interpreters working in mental health settings have training in the D-C Schema and participate in Observation-Supervision training. She also stresses the PBL approach to learning.
Dean recommends that the NCIEC work team look closely at the Alabama Mental Health Interpreter Training Program and curriculum. She thinks that program has done a very effective job training interpreters to work in mental health settings. That program offers, according to Dean, a ‘full continuum’ of training and practicum experience. Dean indicates that the Alabama program, which results in state certification, is more robust and stringent than national certification requirements.
Alabama Department of Mental Health and Mental Retardation, Office of Deaf Services
Mental Health Interpreter Training Program
The Mental Health Interpreter Training Program was formed as a result of a federal/state lawsuit (The Bailey Lawsuit and Settlement). The program is unique in that it is housed and administered at the state level versus part of a college or university. Another outcome of the lawsuit was establishment of a Deaf unit as part of the state mental health facility. In addition, the law provided for four regional coordinators, each of which is a qualified Deaf therapist. The regional coordinators are intended to serve the state’s outpatient Deaf population.
The Mental Health Interpreter Training Program is carried out through completion of four major components of training and education. The first is a 40 hour, week-long extensive training session. It is offered once a year for up to 50 participants. At the end of the week, participants receive a certification of completion. This component of the training program is geared primarily toward certified interpreters. However, if there slots vacant, it has been available to interpreters that have not reached certification if they have prior interpreting experience, including interpreting in mental health settings. Some clinicians have also taken the training, as well as individuals working in the field of Deafness, or interested members of the community.
During the weeklong training, participants receive extensive education on mental health settings, the DSM and different mental health diagnoses and treatments. The objective is to ensure participants understand mental health terminology, and how a diagnosis or treatment impacts on how you interpret. As an example, in the case of a hearing clinician working with a Deaf bipolar patient, the clinician may in a very deliberate way ask the patient a very open-ended question, and drop eye contact. This approach has a direct clinical purpose and is intended to elicit a particular response from the patient. However, if the interpreter misinterprets the clinical objective and does not understand the goal of the session, they may actually unintentionally become a barrier to achieving that goal. The training program weighs so heavily on the DSM and understanding mental health that it also offers a separate eight hour workshop on the topic.
Program participants are also introduced to the concepts of Demand Control Schema and Observation and Supervision by Robyn Dean and Bob Pollard, who participate as instructors in the training, including training for program instructors and mentors on the Supervision aspect. These techniques are designed to assist participants to analyze the mental health setting, assess their options and consequences of those options, and establish the necessary boundaries and professional distance. The concepts of both DC and Observation/Supervision are implemented during the second component of the program training.
The second component of the training program is a practicum. Only certified interpreters that have completed the first training component can participate. Participants are required to complete 40 hours of practicum experience over the course of one year. Each practicum is individualized to the participant. The participant is required to work with a mentor who meets state and training program criteria. CEUS through the independent study option are available for the 40 hours of practicum experience. In addition, participants are required to spend one week at the affiliated state psychiatric unit as part of an observation and supervision experience. In line with the Dean/Pollard approach, participants first observe hearing clinicians and patients and then participate in a supervision discussion and debriefing. They then move into settings that include Deaf patients and qualified interpreters, following the same observation/supervision approach. During the practicum, participants might also spend time or be mentored by the regional interpreters or coordinators who work in the community. This might provide them experience regarding outpatient therapy, day treatment, group home settings, etc.
The participants are provided at the outset a checklist of experiences they need to demonstrate through completion of the practicum, some weighed more heavily than others. They receive a score at the completion of the practicum.
Once participants have successfully completed their practicum, they are required to take a comprehensive written exam on best practices taught throughout the program and what was learned from the practicum. The exam is not designed to ask about symptoms, but includes synthesis geared queries related to the demand control considerations an interpreter might want to assess when interpreting for a particular type of patient (i.e. bipolar patient) in a treatment discussion. The test takes from four to eight hours to complete. Once a participant passes that example, they received state certification as a Qualified Mental Health Interpreter.
The fourth component of the training program is ongoing education maintenance. Participants that have achieved state certification as a Qualified Mental Health Interpreter are required to achieve forty hours of active training or interpreting in the setting per year. This requirement can include CEUs related to mental health, actual time interpreting in mental health settings, and/or participation in on-line assignments and discussions offered monthly by the program. The program also offers periodic workshops on various related topics that count for hours in this regard. In addition, they offer online literature reviews focused on mental health, following which the interpreter can participate in online discussions for CEUs.
The program also offers a clinical training component, geared toward clinicians in the state. The objective is to train clinicians and other mental health providers in how to work with Deaf patients and with interpreters. Both hearing and Deaf clinicians have participated in this training. Professionals have come from many other states to participate in this training.
Finally, the program has produced several DVDs. In one DVD, a number of consumers consented to being videotaped during diagnoses and treatment sessions in order to assist in achieving interpreter training goals. The program has also developed a DVD simulating various interpreting situations. That DVD uses actors. Both DVDs are used in the practicum portion of the training program, and often when the program directors make presentations about the program to outside groups, like RID. To date, they have not made either DVD available outside use in their own program.
A challenged related to the practicum portion of the training is finding enough qualified mental health mentors to work with the number of participants enrolled in the program.
A lesson learned was that it is difficult, sometimes impossible, to make training components for hearing and Deaf interpreter participants comparable. For example, they tried to utilize existing program simulating visual hallucination for CDI participants to parallel auditory hallucination simulations used for the hearing participants. This turned out to be ineffective and was ultimately dropped from the training. The program came to recognize that there cannot always be the same materials/exercises used when training hearing and Deaf interpreters.
They believe they currently have the right level of qualified trainers and presenters for the current training program. However, they have attempted to develop and offer a second forty hour classroom training component to follow the first, but have not been able to find individuals with the depth and combination of experiences to work as instructors for this envisioned training. They would seek to find individuals that are content experts (the clinical side), as well as experts in Deafness, and interpreting. They have had difficulty locating an individual(s) with all three attributes. Currently, they are working on developing these competencies in-house.
Another challenge is with regard to the clinician and other mental health providers. They have found that some clinicians, hearing and Deaf, are typically put off by the need to involve the interpreter in such an extensive manner. These professionals are used to working alone with the patient, and are uncomfortable bringing a third person into the intimacy of the diagnosis and treatment session.
The other challenge is with regard to the interpreter working in this complex setting. Because of all of the inherent things that can go wrong with interpretation in this setting, it puts extreme pressure on the interpreter to ensure that the interpretation is assisting in meeting the goals of the therapeutic session. When working in this setting, the interpreter needs to ally themselves with the treatment process, not the Deaf client, which is a different mindset than working in other settings.
Recommended Training and Education Components
The interviewee provided the following list of competencies that should be addressed in education and training for interpreting in mental health settings:
- Addiction Theory/Issues
- Assess Effectiveness Of Communication
- Assessment Methods
- Case Documentation
- Confidentiality And Privilege (Abuse Reporting, Duty To Warn, Protections Specific To State/Federal Laws/Statute)
- Convey Information Without Alteration
- Cross Cultural Competencies/Sociological Impact
- Cultural Influence Impact On Treatment
- Cultural Views Of MI/MR/SA
- Demand Control
- Discipline Roles
- Emotionally Charged Language
- Inpatient Settings
- Interpreter Role
- Interpreting Vs. Communication Assistance/Language Intervention ?(VGCS AND CDI)
- Linguistic Dysfluency
- Majority/Minority Cultures
- Match Interpreting Method With Client
- Mental Health Issues
- Mental Retardation/Developmental Disability Issues
- Outpatient Settings
- Personal Issues Impact Process
- Personal Mental Health (Self Care)
- Personal Safety Issues/At Risk Conduct
- Personal/Professional Boundaries
- Pre- And Post Conferencing
- Professional Consultant
- Psychopathologies and Symptomology of Major Mental Illnesses/Substance Abuse/Mental Retardation
- Simultaneous/Consecutive/Narrative Interpreting
- Specialized Vocabulary Used In Psychiatric/Substance Abuse/Mental Retardation Settings
- Stereotypes And Impact On MH Service
- Therapeutic Dyad
- Treatment Approaches And Options
- Vicarious Trauma
- Working with CDIs
- Working with Deaf and hearing professionals
Interpreting in Mental Health Settings Workshop
The Interpreting in Mental Health Settings workshop has been offered through the Vancouver Well-Being Program, a government funded program, as well as funded by provincial interpreting associations. Mental health services to Deaf individuals in British Columbia fall under the Well-Being program. The workshop was developed by Karen Malcolm and a therapist as a result of a large scale investigation into the mental health and therapeutic needs of Deaf individuals in British Columbia. A copy of the findings of that study is attached as background to this report (see Appendix D). This workshop is designed for both working interpreters and working therapists as participants. The workshop is offered one weekend each month, and has only been delivered in its entirety one time to date. There have been discussions related to repeating the workshop, but funding is an issue. Karen Malcolm, one of the workshop originators, developed a second workshop designed just for working interpreters. This second workshop has been funded by the provincial interpreting associations. An overview of both workshops is provided below.
This workshop is delivered in a classroom setting. It has two primary components: role play/observation, followed by participant debriefing and discussion. The role play/observation component is based simulation of a one-hour counseling session. Karen Malcolm assumes the role of the interpreter, an experienced therapist serves as the therapist, and a volunteer Deaf consumer that is or has been a client of the Well-being Program plays the part of the patient. The session is based on the real situation of the volunteer consumer. Because this individual is or was an actual patient and is sharing his/her real situation or problem, the individual/situation chosen is typically ‘safe’ and not emotionally charged. The interpreter and therapist workshop participants observe the session, which is captured on videotape.
The classroom debriefing and discussion component of the workshop is based on what occurred and was observed during the counseling session. The workshop participants discuss their observations and reactions to the session. The two role players – the therapist and the interpreter – in turn provide their views about what occurred. The therapist discusses his/her goals and intention of the session, and the interpreter talks about what she thought was happening. The volunteer Deaf consumer also presents their perceptions of what occurred. The debriefing and discussion continues to the next level, during which the videotape of the session is replayed and discussed in more detail. At a certain point, the workshop participants are divided into two groups: therapists and interpreters. The two groups continue to discuss the session from their particular professional perspective.
This second workshop is designed solely for interpreters and delivered over two full days. There were approximately 20 participants in the session, most of which have some previous mental health interpreting experience. However, a few participants had no previous mental health experience. This stream focuses on the provision of tools for conducting pre- and post-session discussions with the therapist in charge, and approaches to foster participant personal growth.
The goal is to provide interpreter participants with tools for initiating and participating in pre- and post-session discussions with the therapist. Participants are divided into small teams and given role playing cards, and assigned one of three roles: therapist, interpreter, or consumer. The role playing card puts forth a particular scenario. For example, the card might say the therapist is resistant to entering into pre- and post-session discussions with the interpreter. With regard to that scenario, the participant assigned the role of interpreter would be provided tools they might use to describe to the therapist the importance and need for those sessions. This stream also focuses on fostering the personal growth of the participants in areas not related to mental illness, but directed toward providing the participant with tools for keeping their distance and not personalizing the issues discussed. To that end, the workshop provides approaches for transference and counter transference; staying safe in settings that become highly charged or violent; balancing compassion, fatigue and burnout, and setting appropriate boundaries.
Therapist participants sometimes struggle with the confidentiality aspect related to the role of the interpreter and having that third person in the room and part of the discussion.
The interpreter-only stream is two days in duration – not long enough to accomplish all that needs to be taught. Because of the limited time available, there is not enough time to touch upon the DSM or specific aspects of mental illness. However, this is considered by the workshop developers to be very important: interpreters need to understand different therapeutic approaches, or they will never truly grasp and understand the intention of the session.
It was also identified that there are many times in mental health settings when consecutive interpreting is more appropriate than simultaneous interpreting. Because the situation is often emotionally charged, and can sometimes involve a spouse or other family members, it often makes more sense to allow the Deaf patient to complete their thought before initiating the interpretation. One issue not adequately addressed by the workshop because of time constraints is provision of decision-making tools to assist the interpreter in determining when to consecutively interpret, and when to take on narrator role.
There are few interpreters currently working in mental health settings in Vancouver, and there is not a lot of funding to provide training to those that are, or expand the number of interpreters that could effectively interpret in this setting.
They do not currently have processes to evaluate changed practices as a result of participation in the workshop sessions, although they do collect session evaluation forms.
Recommended Components of Training and Education
- Education about different therapeutic approaches and the DMDR – specifically, what different interventions look like and the reasoning behind them
- Understanding of DSM categories and what some of the most prevalent symptoms are
- Knowledge of standard psychological tests and issues related to using these tests with Deaf patients
- Tools and techniques for forming a working relationship with the therapist, including when to clarify and direct comments back to the therapists
- Opportunities for therapists and interpreters to be together in the classroom to discuss situations and perspectives
- Role playing, which should be real-time to extent possible
- Opportunities to observe therapists working in mental health settings with actual hearing and Deaf patients
- Observation/supervision approach has great deal of applicability and validity
- Providing practices and tools for interpreters working in highly charged mental health settings that will help them not to personalize the situation and keep the necessary distance
- Methods for establishing boundaries for interpreters working in mental health settings (for example, they should not work in other setting with the consumer they are working with in the mental health setting although the consumer will try to obtain their services in other life settings)
Recommendations for Program Delivery
- On-line orientation to different therapeutic approaches and the DSM
- Real-time and simulated observation opportunities
- Video to present mental health interpreting situations and scenarios (Pollard’s Mental Health Interpreting – A Mentor’s Curriculum, and Treehouse Production videos considered effective)
- On-line discussions as follow up to video
Wright State University, School of Professional Psychology
Training Program in Mental Health and Deafness
The Training Program in Mental Health and Deafness is designed for the participation of both mental health professionals and interpreters. It is offered through the School of Professional Psychology (SOPP). The purpose of the program is twofold: to train mental health professionals in working with Deaf clients and interpreters, and to prepare interpreters for work in mental health settings. The training program is multi-disciplinary, involving five programs, two universities and one college. These include: psychology, psychiatry, mental health counseling, rehabilitation counseling, art therapy and interpreting. The primary goal is to train mental health professionals in working with Deaf clients, and to prepare interpreters for work in mental health settings via didactic and clinical experience. Participants completing the 8 month program are provided a certificate.
The SOPP program is designed to provide supervision of clinical work conducted by mental health students, and of interpreter work done by student interpreters, at a week-night clinic and Saturday morning teaching program. The week-night clinic is a three-hour clinic, open Wednesday evenings during the academic school year (October through May), and offering services to Deaf individuals, couples and families as well as hearing partners and family members of Deaf clients. The Deaf patients have agreed in advance to participate in the program, knowing the counseling session is being observed through a glass mirror. Interpreter and mental health students are assigned to work in pairs so that rules of ethical practice, including confidentiality, for both disciplines are observed. Approximately 50% of supervision of both the mental health students and the interpreter students is conducted during the Wednesday night clinic. The remainder of supervision occurs during the Saturday morning teaching program, held every other Saturday, via case presentations and case discussion of previously videotaped therapy sessions.
The Saturday morning teaching program runs over the course of the full eight months. Members of the Mental Health and Deafness Program teaching team meet every other Saturday for an ongoing training series and to continue discussion on current cases seen the previous Wednesday. The first hour involves a lecture presentation by the clinical supervisor and the interpreter supervisor. This lecture covers a wide variety of topics. The second hour involves current case discussions between the interpreter students, clinical students and supervisors. The remaining time involves presentations to the whole group by area presenters or by videotapes as scheduled. Though there is an open door attendance policy to the training series, case consultation occurs only between the teaching team members.
The SOPP program also offers on-line readings and assignments. Topics include: introduction to mental health; what makes it unique; emotional aspects; substance abuse; chemical dependency; language variations for dysfluent language and idiosyncratic language usage, among others. .
They accept interpreters that are currently working in the field, interpreter practicum students, and psychologists, mental health counselors, as well as students enrolled in study in those fields into the training program. They never separate the two groups (providers and interpreters) and believe very much in the team approach. For example, one session might focus on introduction to mental health, geared toward the interpreter contingent, and the next session might be orientation to Deafness, targeted toward the provider contingent. Students range from age 20 to age 60, and many drive an hour or more to participate in the training.
During the next quarter they will offer for the first time an 11-week, four-credit elective course on interpreting in mental health settings. This course is with the BA Program in Sign Language Interpreting in the College of Education and Human Services; it will be offered as part of a bachelor’s completion program. Participants must have an AA degree and have completed a one year practicum at the school level to be accepted for enrollment. The BA course is designed to provide participants for a ‘taste’ of what is like to work with Deaf patients in a mental health setting. Participants are not expected to exit the program as experts, just be better prepared than before. And while the program does touch upon the DSM and mental health diagnoses, the intent is to create awareness only, and to introduce the participants to the manual the information in it. Students are not expected to understand the DSM; their job is not to diagnose the patient or share the seat with the mental health clinician. As an elective course, it will not be offered every year. The year the program is not offered as an elective, another class called ‘specialized interpreter settings’ will be offered.
The BA training program is new, so they are still learning what will work best.
Because Deaf patients participating in the SOPP program’s Wednesday evening clinic know they are being observed as part of a training program, the types of patients that participate are often not the most challenging of cases to observe, or the type of cases the interpreter is most likely to encounter when actually working in the mental health setting.
There are several large associate programs in close proximity. Students that enter their program are often very mixed with regard to education, experience and background. This is particularly true with regard to the BA program.
Right now the BA program is only open to students already enrolled in Wright State University.
They would like to expand the SOPP program state-wide. They are beginning to post lecture materials on-line so that they can have professionals off-site teach. They also have begun to identify clinicians across the state that could do some distance training, especially on Saturdays, to expand enrollment.
Because the current training SOPP program is offered on a certificate basis versus for credit, they have not collected information regarding outcomes and changed practices.
They will administer entrance testing and at the end of the BA program they require a senior project or portfolio, so there will be results available about outcomes of that program.
Recommended Training and Education
Both interviewees agree that the optimal training and education should include both interpreter and mental health provider participants.
Training and education should at a minimum require an observation/supervision component. They believe their Wednesday evening clinic has been extremely effective in that allows participants to observe actual patients demonstrating real mental health issues. In addition, training and education for interpreting in this setting should include significant opportunity for mentoring and practice, including interpreting for actual Deaf patients.
Videos of Deaf mental health patients would be extremely beneficial. In the mental health setting, no two cases are the same, so the more practice and exposure to actual cases the better. The videotapes could include both hearing and Deaf mental health patients displaying a number of symptoms. For example, a videotape that demonstrates with anxiety looks like.
They cover a number of basic topics as part of their training program. Recommend that any education and training include the same. Below is an example schedule for their program’s didactic series:
- Orientation & Introduction
- Mental Health Providers and Settings
- Well-Adjusted Deaf, ASL, Deaf Culture, Maladaptive Behaviors
- Intake Procedures, Initial Mental Health Issues
- Assessment and Psychological Testing
- Theories and Approaches, Art Therapy, Groups
- Transference and Counter-Transference
- Children and Family
- Mental Illness and Psychosis
- Interpreter Issues – Pre- and Post-Sessions
- Chemical Dependency
- Psychotropic Medication and Psychiatric Treatment
- Forensic and Legal
- Specialty Clients: MR, Deaf/Blind, Minimal Language
Mental Health Interpreting: A Holistic Approach to Effective Practice (3 day workshop)
Is It Me? Building Confidence as a Mental Health Interpreter (3-5 hour workshop)
New Mexico Mentoring Program (16-week on-line curriculum)
Arlyn Anderson has been involved in developing and delivering a number of educational activities focused on interpreting in mental health settings, ranging from a half-day core workshop on the subject, to a three day more intensive workshop, and including development of a 16 week mentoring curriculum.
The three-day workshop, Mental Health Interpreting: A Holistic Approach to Effective Practice, is organized around three primary categories of instruction: 1) understanding mental health settings; 2) establishing emphatic connections to both the therapist and the patient – being effective and supportive but maintaining healthy detachment, and 3) tools and techniques for interpreter self-management, including professional control, setting boundaries and protecting the self (interpreter).
The first category of instruction centers on an introduction to mental health therapy, and covers issues such as psychology, theoretical orientations, including insight oriented therapy, cognitive therapy, family therapy, etc. Interpreters need to recognize there is much more than a ‘conversation’ going on between two people (therapist/patient) in a mental health setting. The workshop explores various therapeutic interventions and modality, the most important being the role of the mental health practitioner and the importance of building and supporting the rapport and relationship between practitioner and patient. This provider/patient relationship opens up a lot of things for the interpreter to understand, including the interpersonal communication between the patient and the provider, and the interpreter’s role in managing that communication and relationship, which is largely psychological and nuanced from person-to-person, case-to-case. The objective is to give the interpreter insight and tools they can utilize to understand the goals of the mental health provider and how to pursue those goals effectively.
The second portion of the workshop goes more in-depth into the role of the interpreter with regard to supporting and working with the therapist, and the importance of establishing that communication and rapport. The objective is to impart to interpreter participants the critical importance of working effectively with the mental health practitioner. It addresses the importance and need for communication with providers before and after (pre- and post-sessions) and during interpreting interactions. This is stressed as a critical part of work in that setting, yet the perception is that few interpreters are doing this. Further, Anderson’s perception is that interpreters are often too intimidated to approach the mental health professional, or may have personalities such that make it difficult to communicate effectively, or even initiate communication. The workshop explores different communication techniques. It includes a video: “Interviews with Therapists.” The video portrays seven therapists expressing their interest in working more closely with the interpreter and their need to understand more about Deaf culture. It is intended to help convince the interpreters that therapists want this communication/relationship with the interpreter.
Anderson also teaches a shorter, core workshop entitled: Is It Me: Building Confidence as a Mental Health Interpreter. This 3-5 hour workshop is designed for sign language interpreters, and has been co-presented with colleague, Gail Nygren. This workshop is targeted to interpreters that are already working in mental health settings. An objective of the workshop is to help interpreters understand role and intentions of the therapists. For example, it explores issues like the type of questions a therapist might pose to a patient in order to lead them into different thought modes. The focus is to establish a sound understanding of the mental health setting and mental health therapy, and to help interpreter participants understand therapy goals, the players, and issues like the difference between psychiatrist, therapist, etc., and the different goals of these professionals.
Anderson has also recently begun presenting her mental health interpreting workshops to spoken language interpreters employed by county and private hospitals in the Twin Cities area. These workshops include the core concepts Anderson feels are central to being “a well-rounded mental health interpreter.” She includes the need to be attentive to provider goals, easy-to-miss therapeutic techniques, e.g. deliberate structuring of verbal interventions, and self-care. She includes experiential exercises designed to increase interpreters’ internal awareness of how unconsciously altering various types of questions can lead a client into or out of an emotional space, thus potentially interfering with provider goals.
Anderson has also recently completed development of a 16-week mentoring curriculum for the New Mexico Mentoring Program on mental health interpreting. The need for this curriculum was driven by the fact that New Mexico is such a large, rural state, and that many of the interpreters working in mental health settings in the state are remotely located and working on their own in a rural environment. The curriculum is based in a 360 page workbook. About one third of the curriculum is focused on mental health and mental illness. The second portion of the training focuses on emotional nuance, which is considered a critical part of the training experience. The third portion of the curriculum simulates activities to practice incorporating emotional nuances into voicing and signing. Currently, many interpreters do not give sufficient attention to the difference, for example, when a patient expresses themselves with mixed feelings, there a number of emotional nuances that are critical to capture for the mental health provider. The training helps interpreters pay attention to emotional nuances and provides opportunities to practice interpretation options. The final portion of the curriculum focuses on working cooperatively and effectively in mental health settings. It provides participants with tools and techniques for approaching mental health providers and other professionals and knowing what to discuss with them. Objectives are to assist the interpreter in understanding themselves, boundaries and sensitivities, and developing a mature, safety-first approach to interpreting in this setting.
Each chapter in the 360 page workbook has readings and self-awareness activities designed to simultaneously expose interpreters to typical activities they might interpret in psychiatric settings and increase self-awareness. There are al so on-going assignments and weekly activities to send to the mentor. The curriculum is delivered through readings in the manual, on-line research activities and email communication with an assigned mentor. The program requires participants to complete about 2-4 hours of work per week, for example, looking up and reporting on a portion of the DSM on line. Over the 16 weeks, participants complete their assignments and submit them to their mentor. An assignment might be to explore the goals of a provider in a particular situation, and how they might utilize something like the DSM. It addresses issues such as variance in the psychological community with regard to how providers view and use the DSM.
As part of the mentoring curriculum, interpreters are also provided a videotape of a Deaf consumer. They are charged with stopping the videotape at various points and providing interpretation. They also are required to tape themselves as they watch the consumer on the video to see how their reactions might manifest themselves on their face as they watch the consumer. This videotape is then submitted to their mentor, who provides a debriefing. An objective of this is to teach techniques for developing professional control: while the interpreter may feel things internally in relation to the situation, they must learn control, and techniques for not expressing them externally. The videotape simulation/practice allows the interpreter to see how their biases and sensitivities might manifest themselves on their face and body, and affect what they communicate in any given therapeutic interaction. Anderson emphasized self-care and self-awareness, and how important it is to develop this, particularly to interpreters that may have never directly been affected or involved in therapy sessions. Participants are also provided the video of the seven therapists (described earlier).
Anderson was also an author of the recently revised Standard Practice Paper on Mental Health Interpreting published by the RID.
While it is critical to pay attention to building the interpreter/provider communication and relationship, many interpreters working in mental health settings do not understand the importance or take steps to build this rapport.
Many interpreters working in this setting will have various degrees of self-awareness and psychological mindedness; some may not have ever experienced therapy or been in a therapy session before. This prior experience can be extremely beneficial for interpreters working in the setting, though it is necessary for these interpreters to add the intellectual component to enable strong boundaries and sound practice. In the absence of prior personal experience, it would be beneficial for interpreters planning on working in the setting to work with a life coach or therapist in order to develop self-awareness and self-management techniques.
Recommended Components of Training and Education in this area
It is important to provide interpreters working in this setting with basic counseling skills, and practice in the role of the therapists to assist them in understanding how the therapist thinks and the goals of a particular treatment.
A video of Deaf and hard of hearing patients talking about using interpreters and their experiences with interpreters would be useful.
Education and training for working in mental health settings should include information and activities related to increasing knowledge and awareness of mental health diagnoses, for example, Deaf individuals, or even hearing individuals, with personality disorders. In that situation, an interpreter may get drawn into a client’s expression of symptoms without even realizing it. Education is needed to provide interpreters with heightened awareness of the various types of mental illness: not to stigmatize the disease or the patient, but with the goal of creating interpreter understanding and awareness and to communicate more effectively with providers.
It would be useful to develop a DVD or videotape of Deaf individuals with different, active mental health symptoms, for example, a borderline psychotic patient, so that the interpreter trainee would be able to observe the symptoms first-hand rather than read about them in the DSM. * Alabama may have such a DVD.
Therapist and other mental health provider involvement in the training and education would be extremely beneficial to both the interpreter and the provider.
Some degree of training in prevention of burnout and vicarious trauma would be beneficial. Therapists and psychologists receive this training, but it is typically unavailable to interpreters working in this setting. This kind of training provides individuals working in the setting with avenues for discharging emotional intensity of the various situations they may encounter. The interpreter serves as the voice for the patient, which in this setting can be emotionally devastating; for example, if the patient’s presenting issues are similar to unresolved issues in the interpreter. It is critical to provide interpreters with strategies for self-awareness and self-care – tools and techniques for ‘staying safe.’ The interpreter needs to be able to work in this setting, process information, and let it go. Anderson has herself completed training on how to be a life coach, which has provided many useful tools and techniques in this area. Anderson recommends – in the best of all scenarios – that interpreters work with a therapist or coach for a minimum of three months to increase self-awareness and psychological mindedness, thereby helping prepare them for interpreting in mental health settings.
Training and education of interpreters working in mental health settings should include an interpreter observation and supervision component. Anderson views the Dean/Pollard Observation Supervision approach as effective. She recommends that future training for work in this setting include opportunity for the interpreter participant to observe the therapist working with an actual patient, and then opportunity to debrief on those observations with experienced interpreters.
Interpreting in Mental Health Settings
VHS Videotape and Instructor Guide
This video was developed by Dan Veltri and Kathleen Duffy for Treehouse Video ten years ago and is still being ordered for use in the field today. The video is 50 minutes long, comes with an instructor guide, and is typically ordered for use as a presentation tool in conjunction with a broader program or workshop being offered. It is most effective when used for education of already certified interpreters.
The video is organized around seven separate vignettes, each presented by professional actors. The vignettes portray various scenarios related to interpreting in mental health settings, each of which is designed to highlight a number of issues that might arise. Examples of situations include patient use of dysfluent language, leaving it up to the interpreter to signal the healthcare professional; hearing therapist overdependence on the interpreter, and leaning on the interpreter as if they are co-therapists with the clinician; therapists and providers who are ‘Deaf-naïve’, among others. The vignettes are purposely designed to be open-ended leaving them exposed to a wide range of interpretation and perspectives.
The interviewee has used the video in conjunction with a 1 ½ day workshop on the topic. In that forum, the video is played vignette-by-vignette. Each time the video is paused, instruction is provided based on the accompanying video instructor guide. Participants are organized into small breakout groups to discuss options and consequences. They share and compare strategies back in the larger group.
The video is dated is several aspects. For example, it refers to technology in terms that are no longer relevant. While the video is ripe for a redo, it is not a priority of Treehouse Video Program. However, the company would be willing to provide the production expertise in a teaming arrangement with content experts from a training institute to update the video.
None of the vignettes demonstrate a certified Deaf interpreter working in the role of the interpreter. This is a major shortcoming of the video; it does not address the role of Deaf interpreters at all, which is a topic coming up more and more often, especially in the larger cities.
The video does not explore testing issues, for example, mental health status exams. These tests were designed and are most effective when used for hearing Caucasian patients. The tests are not as effective when used as assessment tools for Deaf mental health patients.
The video is not well advertised. Treehouse Video Program lists it as a product on their website, but they do not have a catalogue that is disseminated to the field, nor do they market it.
Treehouse Video Program does not have an established mechanism for customer feedback, so it is difficult to determine who is using the video, where, and whether or not it proved effective. Most feedback is anecdotal or word of mouth.
Recommended Components of Training and Education
Participants that seek education and training for interpreting in mental health settings should have prior interpreting education and experience, including work in this setting.
Knowledge of the DSM and a wide range of diagnoses and treatments encountered in mental health settings. Note: It is critical to strike the appropriate balance between imparting sufficient knowledge to be successful in this setting, and not creating the expectation that the interpreter be trained as a mental health professional.
Training and education should offer opportunities for the student to participate in the mental health provider/clinician meetings. This is an important aspect of the education in that it allows the interpreter to better understand the diagnosis and planned treatment of the patient. Again, there needs to be consideration when providing these forums that the expectation is not to prepare the interpreter to be an expert in mental healthcare.
Interpreters working in mental health settings should have access to ongoing supervision – supervision that goes beyond mentoring. They should have access to a sanctioned supervisory network (possibly by RID) that provides a forum for discussing situational options and consequences. There are many gray areas associated with working in this setting where the input, supervision and feedback of an interpreter with substantive experience in mental health environments is critical as a sounding board to the working practitioner.
The Dean-Pollard Observation/Supervision methodology is right on track. Education for interpreters working in these settings should begin with classroom learning, followed by the observation/supervision approach. Students should first observe the mental health clinician working with hearing patients, and then discuss and talk about what they observed. Then they should observe the clinician and an experienced interpreter working with a Deaf patient. Again, the observation period should be followed by the opportunity for discussion of options and consequences. Finally, the student should be provided the opportunity to work with the clinician – but still within the observation/supervision framework.
Education related to interpreting in mental health settings must also address the needs of the healthcare provider/clinician. The interpreter student should be prepared to provide research body resources and suggest materials to the clinician that is uncomfortable with ‘Deafness’. Today, many clinicians are not open to information that will assist them to best utilize the interpreter in the mental health setting. Work needs to be done by the field to create forums for building the relationship between the interpreter and clinician.
Education and training should address the need for standardized behavior on the part of interpreters. Today, across the range of interpreter settings, there are no norms the client, organization or consumer can expect with regard to interpreter performance, attitude and behavior. This is particularly critical in the emotional, highly charged mental health setting.
Recommendations for Program Delivery
Training should be tailored to the level of experience of the participant, and differ greatly with regard to interpreters that are already working in the setting, experienced interpreters that are planning on working in this setting, or novice interpreters entering the field.
Hands on classroom learning, with a heavy emphasis on observation, supervision and interactive discussion and debate, is the most effective approach. However, there may be aspects of the education that could be effectively delivered on-line or through distance learning channels for those experienced practitioners already working in mental health settings.
Interview Guide for Program Administrators
Introduction and Overview of NCIEC
I’ll introduce myself as a consultant that has been working with the Consortium over the past two years. I’ll also provide a brief overview of the NCIEC and its collaborative effort to establish effective practices in a number of key programmatic areas – including mental health interpreting. I’ll inform tell them about the NCIEC Mental Healthcare and Substance Abuse work team, and let them know the work team is leading this effort. I’ll briefly describe the work team’s charge and activities initiated to date. I’ll talk briefly about the draft domains and competencies. I’ll emphasize all of the work that has been accomplished to-date to develop the domains and competencies, and the work team’s effort to obtain the input and feedback of a wide range of experts in the field. I’ll also mention the work team’s ongoing efforts to involve and gather the input of consumers, providers and practitioners from across the country in all of their work.
Purpose of the Interview
I’ll broadly describe what we hope to gain out of the interview process, that is, to obtain input from content specialists like themselves that will assist the NCIEC work team to identify and establish resources to effectively prepare interpreters for work in this setting. I’ll inform them that the Consortium plans to develop a graduate certificate program in Mental Healthcare Interpreting – envisioned as a four-course program designed for on-line delivery in fall 2008. I’ll let them know the curriculum to be developed will be based on the essential elements of effective practice in mental healthcare interpreting, as agreed upon by consumers and experts alike, and will include the input of folks like themselves. I’ll also tell them that another intended outcome of the work team is a resource site on mental health interpreting, and let them know the Consortium will contact them again in the future to discuss potential links to their program through that site.
Information about the Program and the Context in which it Operates
I’ll ask the interviewee to broadly describe their program and to send us any documentation on it. I’ll probe to get them to describe program priorities and identify any challenges or opportunities facing their program, and I’ll ask them to describe the content of their program and the problem/issue it is designed to address. At this point, I’ll ask them on what basis they made decisions for establishing the particular program content. I’ll also ask if the interviewee can provide any demographic information about program participants so we can better understand the characteristics of the interpreters taking this type of education and where they are coming from. For example, are participants coming directly out of other educational programs; are they new graduates versus working interpreters; are they locally based or coming to the program from other parts of the country, etc. I’ll also ask how the prior experience of the participant is impacted by program content (for example, is the program geared for interpreters already working in this setting, or more toward those entering the field; has it had a more positive impact on one or another of these groups). It might also be interesting to understand how participants found out about the particular program, if that information is available.
Description of the Approach or Method Utilized by the Program
The objective will be to understand how the program is delivered, for example through classroom instruction, home study, on-line training, tutoring or mentoring, or through combination of any of the above. I’ll ask them on what basis they made their decisions for the particular approach or method they utilize to deliver their program. I’ll also ask them whether they have found some program delivery methods and processes to be more or less effective than others, and if they have any plans for changing and/or expanding the program and how it is delivered in the future, and the basis for those changes.
Description of Program Outcomes or Results
I’ll ask whether they collect any information that helps them understand the results and impact of their program on participants. Their description might include results based on anecdotes, observations, interviews, surveys, or any other means of collecting feedback from participants. I’ll ask them if they document any of this information, and if so, if they can share it with us. If it exists, this information would be helpful to the workteam as it evaluates the various programs and attempts to make judgments regarding content area or the effectiveness of one approach or method over another.
This is the critical part of the interview process. I’ll tell interviewees that we would like their thoughts regarding the spectrum of education and experience they think is necessary to prepare interpreters to work in this setting. I will encourage interviewees to think outside of the box and envision the best case scenario for education in this area. I’ll say something to the effect: “In the best of all worlds, without time or budget constraints, what education and experience do you believe an interpreter needs in order to be successful in mental health settings?” I’ll probe to investigate their opinions regarding not only with regard to content areas, but delivery options as well. I’ll also ask them to think about the best sequence of education and training, and to characterize their thoughts with regard to interpreters already working in this area, experienced interpreters that are planning on working in this setting, or novice interpreters entering the field.
Discussion of Next Steps
I’ll inform the interviewees that the work team plans on conducting additional information gathering activities, one of which would be to survey working interpreters that have completed education in this area, as well as interpreters that are currently working in this setting. I’ll explain that the objective of the survey will be to get input directly from interpreters regarding the type of education they have found most useful and would like more of in the future, as well as shortcomings and gaps in what is currently available in the field. I’ll ask them if they have conducted any surveys or assessments with the purpose of understanding needs in this area, and if so, whether they can share those instruments and results with us to help inform our own survey design and development. I’ll also ask the interviewees if they would be willing to provide feedback on our survey instrument once we develop it, and whether they would share their program participant lists and contact information so that we can include those individuals in our survey. I’ll also ask them if there are particular questions they would like us to ask in our survey that would help them better understand their own program. I’ll tell them they can provide us with suggested questions when they review our draft instrument.
I’ll thank the interviewee for their time and make sure they know how to access the NCIEC website to stay informed on work team activities and the broader work of the Consortium. I’ll also ask each interviewee if they would be willing to work with the NCIEC in this area, and gauge whether they would be willing to participate in some manner in that effort in the future.
Other Suggested Contacts
Associated with Treehouse Video Productions
Designed and delivered a course on mental health interpreting
Recommended by Izabel Arocaha
Lisa Dignan, Director
New Mexico Mentoring Program
Program recently completed development of a 16 week on-line mentoring curriculum for interpreters in the state working in mental health settings.
Recommended by Arlyn Anderson
Diane Lolli, Director
Cambridge Medical and Mental Health Programs
Responsible for bringing together interpreter content experts and mental health providers to develop Cambridge program; has insight regarding what mental health providers think is most critical for interpreters to understand about mental health settings.
Recommended by Izabel Arocha
Dr. Robert Basil, Program Director
Wright State University, Mental Health and Deafness Program
Provides overall supervision and administration for the mental health program. They also post a lending library list which includes numerous resources for interpreting in mental health settings.
Darlene Zangara, CSD of Ohio
Zangara is a mental health counselor, who is Deaf. She has compiled numerous resources related to interpreting in mental health settings. She also runs a 2-3 day workshop annually, and has done one such workshop on the topic.
Recommended by Greta Knigga
Word and PDF files
Wright State University
Training Program in Mental Health and Deafness – Program Descriptions
CAMBRIDGE VIDEO SERIES
Mental Health Lecture Series for Medical Interpreters
List of Speakers
Gallaudet University Survey Instrument
Karen Malcolm Workshop Session Notes
Interpreting in Mental Health Settings Workshop – Evaluation Report
Developed by the CATIE Center
Revisiting the Interpreter’s Role
Written by Claudia V. Angelelli
Reviewed by Robyn Dean, MA, CI/CT, University of Rochester School of Medicine
Observation and Supervision in Mental Health Interpreter Training
Robyn K. Dan, Robert Q. Pollard, Jr., and Mark Alan English
Teaching Observation Techniques to Interpreters
Jeffrey E. Davis
A First-Hand Account of Observation-Supervision Training
Training Medically Qualified Interpreters: New Approaches, New Applications, Promising Results
Standard Practice Paper on Interpreting in Mental Health Settings
RID Standard Practice Paper
Communication in the Key:
Review of Deaf Mental Health Services in British Columbia?Linda D. Hill, PhD
Patricia Nelson, MA? ?Alabama Department of Mental Health and Mental Retardation
Chapter 580-3-24 Certification of Mental Health Interpreters for Persons who are Deaf
Alabama Department of Mental Health and Mental Retardation
6th Annual Mental Health Interpreter Institute
A Presentation of the Mental Health Interpreter Training Project
1 NCIEC Mental Healthcare and Substance Abuse Interpreting Work Team members: Cathy Cogen, M.Ed., Lead, Regional Interpreter Education Center at Northeastern University (NURIEC); Richard Laurion, CI, CT, NIC, CATIE Center at College of St. Catherine; Rico Peterson, Ph.D., curriculum specialist, NURIEC, Sarah Wedaman, M.A., CI, CT, Mid-American Regional Interpreter Education Center; Diana Doucette, CI, CT, NURIEC (supporting); Brittany Allen, NURIEC (supporting); Karen Dahms, Consultant