Community Ambassador Program Culture and Language Training

1. Community Ambassador Program Culture and Language Training Maria Servin, MSW Service Director Marketing/Diversity

2. The Role of the Interpreter

3. Learning Objectives • Learn from the field of interpreting to learn how to effectively use language skills to assist community members • Increase understanding of the role of an interpreter • Become familiar with tips and techniques when acting as an interpreter

4. The Right to be understood • “ A community interpreter has a very different role and responsibility from a commercial or conference interpreter. She/he is responsible for enabling professional and client, with very different backgrounds and perceptions and in an unequal relationship of power and knowledge, to communicate to their mutual satisfaction.” • Shackman, Jan. The Right to Be Understood, A handbook on working with, empoying and training community interpreters. Cambridge, UK; National Extension College.

5. Building Bridges • Interpreters build a bridge over the language gap that allows people who do not speak the same language to communicate with each other. • The interpreter therefore must be prepared to adjust his/her role depending on the need of the patient and provider.

6. Purpose of the Interpreter • The basic purpose of the interpreter is to facilitate understanding in communication between people who are speaking different languages. • Communication is the interpreter’s main function, and anything an interpreter does should relate to that.

7. Barriers to Communication • Four types of communication barriers: • LINGUISTIC BARRIERS • BARRIERS OF REGISTER AND EXPERIENCE WITH U.S. CONCEPTS AND PROCEDURES • CULTURAL BARRIERS • SYSTEMIC BARRIERS

8. Roles of an Interpreter • To overcome these barriers an interpreter develops skills and takes on four principle roles: • Conduit • Clarifier • Cultural Broker • Advocate

9. Which role to choose? Interpreters flow from role to role • Advocate • Cultural Broker • Clarifier • Conduit

10. Three relationships are established: • Provider - Client • Interpreter - Client • Provider – Community Ambassador • Which is more important? • The only reason the interpreter is involved is to support the “provider - client” relationship.

11. Interpreter vs Translator????What’s the difference? • An interpreter is one who hears information from one language and converts it orally into another language. • A translator is one who takes written information from one language (source language) and writes it into another language (target language). • We will be dealing with the modes for an INTERPRETER not a translator.

12. The Interpreter Code of Ethics

13. Interpreter Code of Ethics • What are Codes of Ethics? • Why do we need them? • How do we use them?

14. Code of Ethics • The skills of a community ambassador requires cultural competence, respect, mastery of colloquial terminology which makes it possible for the trust and accurate communication to take place. • A Code of Ethics sets trained and untrained interpreters apart. • Provide guidelines and rules for interpreters to abide by.

15. Modes of Interpreting

16. Modes of Interpreting • Interpreters use different modes of interpreting under different circumstances. The four modes used include: • CONSECUTIVE INTERPRETING • SIMULTANEOUS INTERPRETING • SUMMARIZATION • SIGHT TRANSLATION

17. SIMULTANEOUS INTERPRETING • The interpreter interprets at the same time that the speaker is speaking, just a few words behind. • This technique is useful when an interpreter is interpreting for a single person in a large group. • It is also useful when patients launch into an emotional speech that cannot be interrupted or in times of emergency.

18. CONSECUTIVE INTERPRETING • This is the most common mode used by interpreters. • It involves a relay, in which one speaker says a few sentences, the interpreter interprets, the other speaker responds, the interpreter interprets, etc. • It closely resembles the way people talk to each other.

19. SIGHT TRANSLATION • This involves taking a document written in one language and reading it aloud in another language. • This is also common when interpreting consent forms, patient education materials, instructions or anything that is written.

20. SUMMARIZATION • When one person speaks at length and the interpreter summarizes the important points at the end. • Summarization is not recommended in medical settings because of the potential for errors and omissions. • If the interpreter is going to summarize, he/she should take careful notes while the person is speaking.

21. Being a Conduit

22. Being a Conduit • The most basic role of the interpreter is that of the Conduit, whose rule is to: • Interpret everything that is said, exactly as it is said: add nothing, omit nothing, change nothing.

23. CONDUIT • The least evasive role. Being a conduit involves rendering in one language exactly what has been said in another language. • Interpret everything that is said, exactly as it is said: add nothing, omit nothing, change nothing.

24. How to be a good Conduit? • Use the first person. If the patient says “My stomach hurts.” The interpreter says “My stomach hurts.” • Interpreting in the first person reinforces the primary relationships. • Interpreting in the first person helps the interpreter focus on repeating exactly what is said. • Interpreting in the first person shortens the communication and avoids confusion as to who is speaking.

25. How to be a good Conduit? (continued) • Interpret pauses, “ums”, sighs, everything or anything that adds meaning to the communication. • Interpreter gives an accurate interpretation not a literal interpretation. • Interpreter also reflects tone, inflection and volume. Include all the information that carries meaning in the message.

26. Being a Clarifier

27. CLARIFIER • The interpreter takes this role when he or she believes it necessary to facilitate understanding. In this role the interpreter adjusts register, makes word pictures of terms that have no linguistic equivalent and checks for understanding.

28. Clarifier • “Well, your thyroid gland is overactive, causing a hormonal imbalance in your system that accounts for many of your symptoms. We suspect that cancer in the thyroid is causing this overproduction. This is a hard one to call. We’ll have to do a radioactive uptake exam followed by a fine needle aspiration to ascertain exactly whether the tumor is benign or malignant.”

29. Basic Interpreter Skills

30. Being a Clarifier • The clarifier may have to change the form of the message significantly in order to be faithful to the meaning of the message. This includes: • Lowering the register: “Register” refers to the level of formal or complex language a person chooses to use. High register speech is very formal and complex. Low register is used in everyday speech. If the provider uses high register the interpreter could: • use high register if he/she thinks the patient will understand • lower the register but not change the meaning, the meaning must stay the same • ask the provider to speak in simpler language • Create Word pictures: Sometimes there are no words with the same meaning. • Symbolic meaning: Symbols have meaning in only one language. • Check for comprehension: Be aware of clues that suggest that either the patient or provider is not understanding. “The interpreter would like to ask if the patient understood.” If the patient is really confused the interpreter should communicate this to the provider so that the provider can explain, not the interpreter.

31. Interpret what is said faithfully but in such a way that the listener can understand; check for understanding. Clarifier Guideline

32. Managing the flow of the Interpreted Session • In an interpreted session, the interpreter is the best person to facilitate the flow of the communication. • Interpreters do this by using a number of techniques: • Introduction and pre-session (with both provider and patient) • use of first person • appropriate intervening • transparent communication • positioning

33. Introduction and Pre-Session • The pre-session helps to set the ground rules for the interpreted session. • Example: “Buenas Tardes mi nombre es Maria, voy a servir como su interprete. Para asegurar la mejor comunicacion le voy a pedir que hable directamente con la enfermera, voy a interpretar todo lo que usted diga, palabra por palabra, use frases chicas, digale lo que usted guste, todo se mantenera con confianza.” • Example for Provider: “Hello this is Maria Servin, I will serve as your Spanish interpreter. There are a few things to help me do a better job of interpreting. First, please speak directly to the patient, I will interpret everything you say exactly as you say it. If there is something you do not want the patient to hear please do not say it. Use short sentences and pause often so I can interpret accurately. If I need you to clarify I will ask you to do so.”

34. Oral rendering of one language of a document written in another language. Sight Translation is a high level skill for an interpreter. Interpreters are asked to sight translate any number of documents: scripts and protocols consent forms registration forms financial aid forms patient education materials instructions, etc. Sight Translation

35. CULTURAL BROKER • In this role, the interpreter provides a necessary cultural framework for understanding the message being interpreted. The interpreter takes this role when cultural differences are leading to a misunderstanding on the part of either provider or patient.

36. Cultural Broker • “People who speak different languages live in different worlds, not the same world with different labels.” Edward Sapir, Noted Linguist • Culture is a shared set of belief systems, values, practices and assumptions which determine how we interact with and interpret the world. • Culturally competent means that we must educate ourselves further about other cultures, the role culture plays in health care and the differences these can generate in the health care setting. WE need to learn specific information about a community and simultaneously treat each person as a unique individual. • We must understand basic cultural frameworks and point out that there are many differences between individuals who come from the same community. • We run the risk of stereotyping if we do not maintain this delicate balance.

37. How to be a Cultural Broker? • The first step to intervening is to be aware that a culture-based misunderstanding may be occurring. • Interpreter should intervene in a “transparent” way, letting the patient know what he/she is going to do, then offer key information to provider. The goal is to get back to interpreting as fast as possible. • Use the following steps: • Be alert to potential cultural barriers • Tell the patient briefly what you intend to tell the provider. • Briefly tell the provider the appropriate information. Don’t give the impression that this is necessarily true for this particular patient, above all avoid stereotyping. • Let the doctor decide what to do with the information. • Go back to interpreting. • Make sure you are: respectful, make no assumptions, not creating or reinforcing stereotypes, get back to interpreting.

38. The Role of Advocate

39. The Role of the Advocate“Washing one’s hands of the conflict between the powerful and the powerless means to side with the powerful, not to remain neutral”Paulo Freire What is advocacy? • Advocacy is the most controversial of the interpreter roles. • Guidelines must be established to help interpreters know when they are advocating appropriately and when they are invading the patient/provider prerogative. • Interpreter must be taught skills necessary to advocate well so as to increase trust rather than undermine it.

40. The Role of Advocate • There are times when advocacy is not appropriate. • These include: • when the contested decision is based on medical expertise, and there does not appear to be a misunderstanding or oversight • when the patient does not want to continue • when the patient needs a service not provided for by anybody else • when the request is of primary benefit to the interpreter and not the patient • when advocacy would involve breaking confidentiality

41. ADVOCATE • Advocacy is any action an interpreter takes on behalf of the patient outside the bounds of an interpreted interview. • The advocate is concerned with quality of care in addition to quality of communication. • Interpreters appropriately become advocates when the needs of the patient are not being met due to a systemic barrier such as the complexity of the health care system or racism. • Advocacy most often takes the form of giving information or connecting the patient to other clinic staff whose job it is to resolve the patient’s problem.