use of interpreters in a mental health setting february 19, 2009 lidia gamulin, lcsw dj ida, ph.d....

41
USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural and Linguistic Competence Community of Practice

Upload: phillip-chapman

Post on 12-Jan-2016

212 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

USE OF INTERPRETERS IN A MENTAL HEALTH SETTING

FEBRUARY 19, 2009

LIDIA GAMULIN, LCSWDJ IDA, PH.D.

MARIE SANCHEZ, MA

Technical Assistance Partnership

Cultural and Linguistic Competence Community of

Practice

Page 2: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Outline

o Need for interpreters in systems of careo Federal regulationso Current workforce issueso Consequences for not using properly trained

interpreterso Roles/models of interpretingo What an interpreter is noto Helpful hintso Systems issues

Page 3: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Serious Disparities of Quality Care for Communities of Color:

The lack of representation of service providers in mental health from the Latino, African American, Asian American/Pacific Islander and Native American communities has resulted in serious disparities of quality care for all communities of color

These disparities are particularly critical for those

with limited English proficiency who remain isolated not only by cultural barriers but also language barriers that prevent them from receiving proper care

Page 4: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Mental Health Interpreter Training

Goals

To produce culturally competent interpreters who are able to identify the language and cultural interpretation needs of the monolingual and limited English proficiency clients

To help interpreters gain the knowledge and skills to perform effectively in the interpreting roles that best serve the clients and the providers in mental health settings

Page 5: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Need for Training Interpreters

There continues to be a serious lack of trained bi-lingual, bi-cultural service providers

Only 6% of psychologists, 8% of counselors and 11% of social workers are from communities of color

US Dept. of Health and Human Services, Center for Mental Health Services (2001)

Having a Ph.D. or MD does not guarantee that a person will be culturally competent

Being bi-lingual does not in and of itself qualify a person to be clinically qualified

Page 6: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Interpreter as Part of Professional Team

Culturally competent Provider

Linguistically proficienttrained Interpreter

Quality services for consumers and family

+

=

Page 7: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Federal Regulations

• Title VI – Civil Rights Act of 1964

• Executive Order 13166 (August 2000)

• The President’s New Freedom Commission on Mental Health

• Office of Civil Rights Regulations

• Culturally and Linguistically Appropriate Services (CLAS)

• The National Council on Interpreting in Health Care (NCIHC)

- First National Standards for Medical Interpreters- 32 Standards – November, 2005

Page 8: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

The National Council on Interpreting in Health Care (NCIHC) November, 2005

First National Standards for Medical Interpreters32 Standards

http://www.ncihc.org

Page 9: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

California State Department of Mental Health

Threshold Languages

Definition of Threshold Language:

3,000 Medi-Cal Beneficiaries or 5% of Medi-Cal population whose primary language is other than

English, whichever is lower

oList the threshold languages in your county

oWhat are the threshold languages in your

community?

oHow well are these needs being met?

Page 10: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

The Value of Properly Trained Interpreters

o Improves communication between client and

service provider

o Improves capacity to gather accurate background

information

o Allows for appropriate assessment, diagnosis,

testing and screening

o Can function as a cultural broker

o Results in better understanding of treatment plan

and reduces unnecessary hospitalization

Page 11: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

The Value of Properly Trained Interpreters (cont’d)

o Expands a client’s choices in accessing clinicians – assuming the clinician is culturally competent

o Helps client be better informed so he/she can fully participate in development of his/her own treatment

o Use of interpreters is a cost effective means of providing services

o Helps fulfill legal requirements in providing quality services

o IMPROVES QUALITY OF CARE

Page 12: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

George Bernard Shaw once said that Great Britain and America are two countries divided by a common

tongue.

An American car has: British cars have a: a trunk boot a hood bonnet a windshield windscreen and runs on gasoline and burn petrol

If a British gentleman asks a lady for a rubber, he only desires an eraser. And when he promises to knock her up at five, he only intends to visit her in the early evening.

Page 13: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Questions & Comments

Questions/Comments

Please press * 7 to unmute your phone and press* 6 to mute it again

Page 14: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Roles of an Interpreter

Clarifier

Conduit

Cultural Broker

Advocate

Page 15: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Cultural Broker

A cultural interpreter or cultural broker is an active participant

in a cross-cultural/lingual interaction, assisting the clinician in

understanding the beliefs and practices of the consumer’s

culture and assisting the consumer in understanding the

dominant culture, by providing cultural as well as linguistic

links. This model of interpreting services was developed out of

the awareness that communication is seriously impaired by

insensitivity to the role of culture in the content and manner of

communication, particularly in formal interactions. Source: Bridging the Gap: A Basic Training for Medical Interpreters (1999). SeattleWA: Cross Cultural Health Care program

Page 16: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Translation vs. Interpretation

Translation is the conversionof a message from the source languageinto written form in the target language

Interpretation is the conversion of a message (usually oral) from one language ( the source language) into oral form in another language (the target language)

Page 17: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Models of Interpreting

o Consecutive interpreting

o Summary interpreting

o Cultural interpreting

o Simultaneous interpreting

o Sight translation

o Relay interpreting

o Telephone interpreting

o Video Monitoring Interpreting VMI

Page 18: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Client Interpreter #1

Interpreter #1 Interpreter #2

Interpreter #2 Provider

Relay Interpreting

Page 19: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Would you drink this?

When “Coca Cola” was first

translated phonetically into

Chinese, it sounded like,

“female horse stuffed with wax…”

Page 20: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

What an Interpret is Not

o A mental health clinician, therapist or diagnostician

o They should not be placed in the position of making clinical decisions

o They are also not just a “dictionary”, i.e. they also bring invaluable cultural expertise to the sessions

Page 21: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Therapeutic Triad

Provider

Interpreter Client

Verb

al &

Non

-Ver

bal

Non-verbal

Verbal & Non-Verbal

Page 22: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Never Use a Child as an Interpreter

o This places the parent in a lower status position which results in loss of face

o This places the child in an emotionally difficult position of taking care of the parent

o This may be asking a child to communicate information which is beyond his/her developmental capabilities, leading to feelings of incompetence

Page 23: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Never Use a Child as an Interpreter

o Information may not be accurately translated

o May be asking child to divulge family secrets which jeopardizes his/her relationship within the family

o Child may not wish to share information but feel compelled since person asking is in position of authority

Page 24: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Identify Appropriate Language

o This includes knowing proper dialect. Critical information may not be translated properly if using wrong dialect

o Ask what language the person speaks, not where they are from as this may be different

o Emotions/difficult concepts are usually best expressed in a native language

Page 25: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Service Provider Must be Culturally Competent!

Being culturally competent is the responsibility of the provider.

If a clinician is culturally incompetent ~ interpreting insensitive information only guarantees incompetence

in two languages!

Page 26: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Use Trained Interpreter Only

o If not properly trained, interpreter may give inaccurate information

o Even if person appears to be fluent in English, technical information and terminology may not be understood and accurately interpreted

o Needs to be familiar with clinical/legal/medical termso Must be sensitive to implications of culture and how this

impacts on individual's responseo If not properly trained may withhold information if

he/she feels it is "shameful" or damaging to client

Page 27: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Special Concerns

o Allow for extra time.

o Allocate appropriate resources –To not use interpreter will cost more later both financially and in quality of life. Use of interpreter is critical for quality care.

o May require creative solutions to train and use interpreters for languages with limited population

Page 28: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Helpful Hints

o Address comments to the individual – not only is this a sign of respect, the person may actually understand more than he/she conveys

o Do not direct comments to interpreter – this ignores the individual and makes him/her feel discounted

o Allow interpreter to use cultural norms in conveying message, communication styles

o Speak slowly and allow interpreter to translate every few sentences

Page 29: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Helpful Hints

o Ask for clarification to make sure information is conveyed and received accurately

o Do not assume if person nods in agreement or says yes that he/she understands what was said

o Own problem of communication - do not blame person.

o Allow interpreter to use cultural norms in conveying message, communication styles

Page 30: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Helpful Hints

o Clarify if person understands what has been said

o Review proceedings with interpreter in advance so he/she is familiar with your expectations of interview, evaluation, etc.

o Debrief with interpreter to see if there is information that needs to be clarified or may have been communicated non-verbally by individual.

Page 31: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Questions & Comments

Questions/Comments

Please press * 7 to unmute your phone and press* 6 to mute it again

Page 32: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Systems Issues

o Develop policies that clearly outline job description

o Provide adequate compensation for language

capabilities of staff

o Identify resources to pay for interpreting services

o Require training to work specifically in mental

health

Page 33: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Recommendations

1. Provide training to interpreters to work specifically in multicultural mental health settings

2. Develop job descriptions to clarify roles of interpreters and bi-lingual staff

3. Provide appropriate compensation for interpreting services

4. Provide ongoing support and supervision for interpreters

Page 34: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Challenges

What are challenges you face within your own community?

What resources do you need?

What are success stories?

Page 35: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Do You Have Interpreting Policies?

Examples:

Use only trained interpreters to ensure accurate communication

Prohibit use of minor children as interpreters

Provide for bilingual differential – bilingual bonus

Provide 800 access number for languages that are not available

Determine verbal, reading and writing proficiency using standardized exams.

Page 36: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Mental Health Interpreting Project

California Department of Mental Health

National Asian American Pacific Islander Mental Health Association

National Latino Behavioral Health Association

Texas Department of Mental Health/Mental Retardation

Page 37: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Training Schedule-Day 1

o Overview of Training Objective and Scheduleo Why the need for interpreters in the mental

health setting

o Cross-Cultural Communication

o Cultural Self-Awareness

o Understanding the role of Culture in Mental

Health

Page 38: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Training Schedule-Day 2

o Interpreter Role and Stages of

Interpreting

o Models of Interpreting

o Pre-session, In-session and Post-session

o Code of Ethics

o Self Care Techniques

Page 39: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Training Schedule-Day 3

o Mental Health Terms, Diagnosis, Services

o Cultural Bound Syndromes

o Mental Health Systems

o Patient’s Rights

o Review

o Evaluations

Page 40: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Closing Questions & Comments

Questions/Comments

Please press * 7 to unmute your phone and press* 6 to mute it again

Page 41: USE OF INTERPRETERS IN A MENTAL HEALTH SETTING FEBRUARY 19, 2009 LIDIA GAMULIN, LCSW DJ IDA, PH.D. MARIE SANCHEZ, MA Technical Assistance Partnership Cultural

Contact Information

For information on Training:A. Marie Sanchez, MHIT Project Manager

National Latino Behavioral Health AssociationPh: 970-532-7210; Fax 970-532-7209

[email protected]

Lidia Gamulin, [email protected]

Dr. DJ Ida, 303-298-7910 National Asian American Pacific Islander

Mental Health [email protected]