use of interpreters in a mental health setting february 19, 2009 lidia gamulin, lcsw dj ida, ph.d....
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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
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
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
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
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
Interpreter as Part of Professional Team
Culturally competent Provider
Linguistically proficienttrained Interpreter
Quality services for consumers and family
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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
The National Council on Interpreting in Health Care (NCIHC) November, 2005
First National Standards for Medical Interpreters32 Standards
http://www.ncihc.org
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?
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
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
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.
Questions & Comments
Questions/Comments
Please press * 7 to unmute your phone and press* 6 to mute it again
Roles of an Interpreter
Clarifier
Conduit
Cultural Broker
Advocate
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
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)
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
Client Interpreter #1
Interpreter #1 Interpreter #2
Interpreter #2 Provider
Relay Interpreting
Would you drink this?
When “Coca Cola” was first
translated phonetically into
Chinese, it sounded like,
“female horse stuffed with wax…”
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
Therapeutic Triad
Provider
Interpreter Client
Verb
al &
Non
-Ver
bal
Non-verbal
Verbal & Non-Verbal
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
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
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
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!
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
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
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
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
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.
Questions & Comments
Questions/Comments
Please press * 7 to unmute your phone and press* 6 to mute it again
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
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
Challenges
What are challenges you face within your own community?
What resources do you need?
What are success stories?
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.
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
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
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
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
Closing Questions & Comments
Questions/Comments
Please press * 7 to unmute your phone and press* 6 to mute it again
Contact Information
For information on Training:A. Marie Sanchez, MHIT Project Manager
National Latino Behavioral Health AssociationPh: 970-532-7210; Fax 970-532-7209
Lidia Gamulin, [email protected]
Dr. DJ Ida, 303-298-7910 National Asian American Pacific Islander
Mental Health [email protected]