Julie Simon presenting part of Team Interpreting workshop

Deaf/Hearing Teams in the Healthcare Setting

Facilitated by Nigel Howard and Julie Simon

As a follow up to Nigel Howard’s Plenary Address and Jimmy Beldon’s response, Nigel Howard and Julie Simon presented an afternoon session on the concept of “co-interpreting” in healthcare settings. The term co-interpreting refers to a relationship between Deaf and hearing members of a healthcare team that views the status of each member of the team as equal with the goal of assuring successful communication for their consumers. The choice of the term co-interpreter is parallel to use in legal settings, where lawyers who collaborate on a case refer o each other as co-counsel. As they emphasized throughout, “It’s not about the interpreters! It’s about the communication.”

NIgel Howard presenting

Photo Credit: Rebecca Zenefski, By Rebecca Studios

The goals of the workshop were to understand the dynamics of interpreting, to understand the importance of shared expectations and understanding, and to understand our own needs within the team.

They started out by looking at the perceptions of Deaf Interpreters from the Deaf Community, from the interpreting community, from the Deaf Interpreter community, and from the medical community. As mentioned in Doug Bowen-Bailey’s blog about Nigel’s plenary lecture, the Canadian use of the term D.I. is different from the U.S. use of this term. For this reason, I will use D.I. for Nigel’s use and for the broader U.S. notion of Deaf Interpreter. While in the U.S. DI refers to any working Deaf interpreter independent of certification status, attainment of D.I. status involves different training and vetting, more comparable to the CDI.

From the Deaf Community

The Deaf community has been resistant to using Deaf interpreters because it’s a new experience, but once they’ve seen how qualified D.I.s work and how effective they are as interpreters in various situations, those resistances have gone away and they are much more receptive to using D.I.s. The D.I. is seen as an effective component of the process when the Deaf-Hearing co-interpreters work as an efficient unit.

From the Interpreting Community

Membership for D.I.s in AVLIC requires documentation of completion of an interpreter training program. There is some resistance by certified and trained interpreters toward D.I.s because they have not completed an ITP program, training etc. They noted that if a Hearing Interpreter resists working with a DI, it is important to figure out why. Nigel also noted that experienced interpreters are most likely to request Deaf co-interpreters, while less experienced interpreters are least likely to do so. For this reason, they recommend that the decision not to use a Deaf interpreter should involve input from a Deaf interpreter. The default should be a D/H team until the co-interpreters together determine there is no need.

From within the D.I. Community

The D.I. community decides who is an appropriate D.I. and the progression of experiences they need to have as they move up in the field. If someone tries to skip a step and jump beyond their competencies the D.I. community feels the responsibility to put the clamps on them.

From the Medical Community

The medical community is beginning to recognize the role of D.I.s in providing comprehensive access in healthcare. Julie noted that when she started there was Legal, Educational and Community interpreting—medical was part of community and not really recognized as a specialization. That has been changing. There are several large medical centers with staff interpreters who regularly call in D.I.s—Vancouver, Boston, etc. And, I can add Portland, ME as well.

After addressing perspectives on Deaf interpreters, Nigel and Julie went on to discuss the professional behavior and roles of co-interpreters.

What are the roles of the co-interpreters?

Co-interpreters need to figure out how to work as a unit. It is a slow process of becoming a well-oiled team. It doesn’t happen overnight. It is not the case that each member of the team works in isolation without monitoring or input from the other. There are even times when one or the other member of the team is not needed to complete the interpretation. For example, in cases of sight translation, the translation need not go through both. The D.I. might do the sight translation directly. The team may use an open process model of interpreting where at times the hearing interpreter may interpret directly to the consumer. The entire teaming relationship focuses on how best to handle the communication. There is no room for egos. The basis of the co-interpreter teaming relationship is trust.

To function as a unit, the team must build a connection. Nigel prefers to know for every assignment who the co-interpreter is. He prefers to meet before. For example, at the upcoming World Federation of the Deaf Congress in Istanbul, Nigel knows every member of the extended team he will be working with, but he still wants to informally meet and connect with them before working together. As with any teaming, interpreters have differing approaches and may or may not be a viable match for each other.

What are the responsibilities of the 2 interpreters?

The role of the D.I. as an interpreter is the same as that of a hearing interpreter. In Nigel’s opinion the D.I. is bound by the same code as the hearing interpreter, with the same roles and responsibilities. The D.I.’s role is not more flexible.

What’s the difference between an advocate and an interpreter?

Despite having two hats, one as a member of the Deaf Community and the other as an interpreter, the D.I. needs to inhibit any tendency to advocate.

In terms of the team, personal and professional conduct reflect back equally on both members of the team. Relevant factors to consider are maturity, boundaries, and accountability. Boundaries involve working together to do the job without being an advocate, a cheerleader or any other inappropriate role. The co-interpreters need to monitor each other in this regard. They need to listen to each other and work together to achieve message equivalence. In terms of accountability, they need to monitor each other. While the D.I. is interpreting, the co-interpreter monitors and if something is off, they offer a correction and vice versa.

Nigel and Julie noted that trust is critical. If the co-interpreters start out trusting each other, then the consumers will trust them. If the team is collectively confident, then consumers will trust what they are doing. Tentativeness or lack of confidence in each other can be seen as a lack of competency. But there are necessary checks and corrections as well.


Team interpreting is the utilization of two or more interpreters who support each other to meet the needs of a particular communication situation (RID Standard Practice Paper, Team Interpreting, www.rid.org). Team interpreting refers to two or more interpreters working together, not just physically, but intellectually (Stewart, Schein, % Cartwritght, 1998, P. 107).

Co-interpreting considerations include communication with the co-interpreter before, during and after the assignment. If there isn’t time, it is important to make time to communicate over Skype or some other means later. Nigel made the point that “You did a good job” is not the kind of post processing he is looking for. It is more important for the team to discuss with each other individual decisions each of them made and focus on the reason they made these choices—the why. Only in this way can they get of deeper understanding of each other’s process.

Everyone varies in how and in what chunks they give and receive feeds. Understanding each other’s styles is critical. Nigel characterized this as learning to dance with each other. Process and logistical dynamics is also a team effort. Nigel raised the example of he D.I. conveying the information in “Take two pills and hour before each meal up to 6 pills a day.” The hearing consumers may become impatient or concerned as he expands the question to “So, what time do you usually eat breakfast. Ok, 8 a.m.? Then take two of the pills at 7 a.m. And, what time do you typically eat lunch? Okay, noon? Then take two pills at 11 a.m., etc.” Often when this back and forth is happening in the interpretation of what seems like a simple question to the hearing consumer, the hearing co-interpreter will escort interpret and explain the process to them.

Co-interpreters need to make many decisions individually and together. Both personal and professional considerations come to bear on the decision to accept an assignment. Nigel cautioned interpreters to self-reflect on their readiness to take on given assignment based upon skill-level, background knowledge, and a variety of other factors. The members of the team have accountability to the consumers prior to accepting the assignment and through to the conclusion of the assignment. There are also joint decisions that need to be made. The team needs to work together to diagnose any problems that arise, consider all the perspectives, consider possible solutions and the possible ramifications of decisions made. They need to discuss approach and how to handle the issues in a professional manner. Professional and personal aspects of he decisions need to be considered.

Jimmy Beldon responded to the plenary talk with a series of thought provoking questions of his own as well as many others from the audience and a lively discussion ensued. Topics included the issue of being an advocate versus being an ally, protocols for team interaction, and numerous scenarios. We benefited from many examples of modeling of team interactions by Nigel and Julie.

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