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Welcome!. How to Effectively Communicate Through an Interpreter. Adelya Carlson Director, Training and Outreach Northern Virginia AHEC. Welcome!. NV AHEC. Community-Based Non-Profit Part of Nationwide Network Mission:

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how to effectively communicate through an interpreter
How to Effectively CommunicateThrough an Interpreter

Adelya Carlson

Director, Training and Outreach

Northern Virginia AHEC


nv ahec
  • Community-Based Non-Profit
  • Part of Nationwide Network


To Support the Health Care Workforce which Serves Vulnerable Populations


At the conclusion of this session, you will :

  • Know the difference between interpretation and translation
  • Understand regulatory requirements as they relate to language
  • Recognize the importance of using trained interpreters
  • Know what to expect and how to manage an interpreting encounter
shadowing exercise
Shadowing Exercise

Pair Exercise

  • Choose a role (Reader/Interpreter)
  • The reader will read each sentence and then pause for the interpreter to “shadow”
  • Without looking at the paper, the interpreter will repeat what the reader says in English.
  • When Interpreter #1 has finished shadowing the first paragraph, switch roles.

Was this exercise challenging? Why?

interpretation vs translation
Interpretation vs. Translation

What is the difference between

interpreting and translating?

interpretation vs translation1
Interpretation vs. Translation


  • Transmission of an oral message in one language into an oral message in another


  • Transmission of a written message in one language into a written message in another
why are we here
Why are we here?

While English is the predominant language spoken in the United States,

there is a growing number of persons who speak English “less than well” or who are “Limited English Proficient” (LEP)

who is a limited english proficient lep person
Who is a Limited English Proficient (LEP) Person?

An LEP individual is a person who;

  • Does not speak English as their primary language
  • Has a limited ability to read, write, speak or understand English
true or false
True or False?
  • Most LEP persons are poor, immigrants or minorities
  • Most people with Limited English Proficiency have low IQs
  • People with Limited English Proficiency have trouble reading
  • People with Limited English Proficiency have low education levels
why do we need trained interpreters
Why do we need Trained Interpreters?
  • As a Result of Changing Demographics
  • To Abide by Regulatory Requirements
  • To Manage Risk
  • To Ensure Quality Service
changing demographics1
Changing Demographics
  • 2000 US Census: Over 200 different languages are spoken in the US
  • In the past 10 years this number has greatly increased

“Who speaks a language other than English when at home?”

2006 american community survey
2006 American Community Survey

19.7% of US residents over age 5 speak a language other than English at home.

      • More than 45 million people

Of this population…

  • 8.7 % speak English “less than very well”
      • More than 11 million people
  • 27% live in “linguistically isolated households”

(households where no member 14 years old and over speaks “only English” or speaks English “very well”)

changing demographics in virginia
Changing Demographics in Virginia

“What about in your area?”

regulatory requirements
Regulatory Requirements

Which laws apply to organizations receiving federal funds in connection to language?

title vi of the 1964 civil rights act
Title VI of the 1964 Civil Rights Act
  • Applies to any federally funded institution or program
    • Health and Human Service Organizations
  • Prohibits discrimination on the basis of race, religion, sex, or national origin
  • Insures equal access to services provided by those institutions and programs
to whom does title vi apply
To Whom Does Title VI Apply?

“Covered entities” include all recipients of federal financial assistance through:

  • Grants
  • Loans
  • Contracts
  • Training
  • Use or donation of equipment or property
  • Indirectly through state agencies, county agencies, private agencies
title vi of the civil rights act of 1964
Title VI of the Civil Rights Act of 1964

Recipients of federal financial assistance shall not:

  • Deny an individual a service, aid, or benefit
  • Provide a benefit, etc. which is different or provided in a different manner
  • Subject an individual to segregation or separate treatment
2000 executive order 13166 title vi of the 1964 civil rights act
2000 Executive Order 13166Title VI of the 1964 Civil Rights Act
  • Courts consistently rule “national origin” provision covers people with limited English proficiency (LEP)
  • Insures access to interpreting services free of charge
  • Discourages use of family, friends and minors as interpreters
  • Stresses the importance of language testing and training of interpreters
how to comply with title vi
How to comply with Title VI
  • Identify LEP persons needing assistance
    • I Speak cards
  • Take language assistance measures
    • Interpretation services
    • Translation of “vital” documents
  • Train staff
    • LEP policies and procedures
    • How to communicate effectively through interpreters
  • Provide notice of services to LEP population
    • Bilingual signage
language service measures interpreter service options
Language Service MeasuresInterpreter Service Options
  • Staff interpreters
  • Bilingual staff
  • Contract with an interpreter service
  • Use telephone interpreter service
  • Volunteer or Community interpreters
possible scenarios that could violate title vi
Possible scenarios that could violate Title VI
  • A Handout
  • Read each scenario
  • Determine how the scenario violates Title VI of the Civil Rights Act
hhs lep policy guidance
HHS LEP Policy Guidance
  • Clarifies the principles of Title VI with respect to LEP persons
  • Details reasonable policies and procedures to ensure meaningful access of services by LEP persons

Copies are available on OCR’s website

managing risk
Managing Risk

According to American Academy of Pediatrics:

  • The Untrained Interpreter makes an average of 31 errors during a 15 minute encounter
  • 63% of the errors made have clinical consequences
common type of errors in medical interpretation
Common Type of Errors in Medical Interpretation
  • 52% Omission
  • 16% False Fluency
  • 13% Substitution
  • 10% Editorializaiton
  • 8% Addition
the untrained interpreter1
The Untrained Interpreter

As a result of the untrained interpreter’s

Errors, omissions, additions and substitutions

Medical history

Drug allergies and potential drug interactions

Duration, dosage, frequency of medication

Complex medical terminology and concepts

And because the

Lack of confidentiality may cause patients to withhold important information

The untrained interpreter

Fails to insure accuracy, completeness, understanding

Which may

Lead to negative clinical consequences


Unnecessary testing

Inappropriate treatment

However, because the interpreter is untrained

Providers and patients have no basis on which to determine whether or not their messages have been completely and accurately interpreted

Jeopardizing the client’s well being

Exposing the provider to liability risks

trained interpreters
Trained Interpreters

According to National Cancer Institute of the National Institutes of Health research, trained interpreters:

  • Accurately interpreted most (74%) of the conversation

(range: 47%-98%)

  • Had higher accuracy during non-technical portions of the discussion in comparison with the technical portions.
quality of service1
Quality of Service

Without interpreters:

  • Providers cannot do their jobs
  • Patients cannot access services to which they are entitled
quality of service2
Quality of Service

Trained Interpreters;

  • Highly proficient in both languages
  • Bicultural as well as bilingual
  • Bound by Code of Ethics
  • Employ techniques to ensure accuracy and understanding
  • Knowledge of medical concepts and terminology
  • Understand the US healthcare system
the trained interpreter
The Trained Interpreter

Studies show:

Patients with access to a trained interpreter were more likely to:

  • Attend outpatient appointments
  • Ask providers questions
  • Understand options and participate in decisions
  • Follow medication and treatment instructions
  • Have better outcomes and physical functioning
  • Develop a trusting relationship with the provider
  • Be satisfied with the level of care

Doctors working with trained interpreters were more likely to:

  • Make accurate diagnoses
  • Establish effective treatment plans
  • Understand the significance of their patients’ cultural perspectives and practices
what to expect
What to Expect

A trained interpreter will:

  • Make an introduction to all parties
  • Abide by the Interpreter’s Code of Ethics
  • Speak in the first person while transmitting a message
  • Utilize various modes of interpreting according to the situation
  • Employ techniques to address barriers to communication and ensure understanding
the interpreter s introduction
The Interpreter’s Introduction

Setting Ground Rules & Managing Expectations

  • The interpreter will establish:
  • Who they are
  • What they will interpret
  • Confidentiality
  • To whom the client/provider should speak
  • Expectations regarding sentence length and pauses
the interpreter s code of ethics





The Interpreter’s Code of Ethics
the interpreter s code of ethics1
The Interpreter’s Code of Ethics

Prevents the interpreter from;

  • Discussing what takes place during an interpreting encounter


  • Giving opinions or advice

Client Self Determination

  • Engaging in conversations with clients/providers outside of the interpreting encounter

Attitude Toward Client

  • Remaining in a room alone with one party if the other party isn’t present

Attitude Toward Client

  • Accepting compensation directly from the provider/client in the form of gifts, tips, services, etc…


Requires the interpreter to;

  • Interpret everything that is said in the room


  • Provide all sight translations in the presence of the provider


  • Ensure that the client/provider have understood the interpreted message


  • Withdraw from an encounter if a violation of the Code of Ethics occurs during an encounter

Ethical Violation

narrative mode and posture first person gaze low
Narrative Mode and PostureFirst Person, Gaze Low

When transmitting a message during an interpreting encounter, the trained interpreter:

Utilizes the First Person

  • Promotes accuracy and understanding
  • Is more efficient
  • Makes clear the interpreter is not the source of the message

Maintains a Low Gaze

  • Reinforces that the interpreter is not the source of the message
  • Reinforces interpreter's role as a conduit, strengthening client/provider relationship
4 modes of interpretation
4 Modes of Interpretation

Consecutive (Most Common)

  • With pauses for the interpreter to interpret
  • Parties must engage in a direct exchange of dialogue

Sight Translation

  • Transmission of a written text into an oral message
  • Parties must process written information in a foreign language


  • Interpreting at the same time the speech is being made
  • One person addresses a large group
  • A person can’t or won’t stop talking

Whispered Simultaneous

  • Interpreting in the simultaneous mode in a whisper
  • Only a few group members don’t understand a message being presented to a group
  • Audio equipment is not available
interpreting techniques
Interpreting Techniques

Addressing Barriers to Communication &

Ensuring Understanding


  • Linguistic Barriers
  • Interpreter speaks in the 3rd person, gaze up


  • Cultural Barriers
  • Interpreter speaks in the 3rd person, gaze up
how to effectively communicate through a trained interpreter
How to Effectively Communicate Through a Trained Interpreter
  • Following ground rules laid out by the interpreter during the introduction
  • Speak directly to the patient
  • Pause frequently
  • Use First Person
  • Check for understanding
assessing interpreter competency
The recipient should take reasonable steps to determine whether the untrained interpreter:

Is proficient in both English and another language

Has knowledge of specialized terms or concepts appropriate to the need

Understands the need for confidentiality and impartiality

Is able to fulfill the role of interpreter without deviating to other roles

Assessing Interpreter Competency
how to effectively use an untrained interpreter
How to EffectivelyUse an Untrained Interpreter


When working with an untrained interpreter;

  • Set some ground rules
  • Insist that the interpreter speaks in the first person
  • Interrupt quickly if interpreter engages in side conversations
  • Check for understanding
role play
Role Play



interpreting exercise
Interpreting Exercise

Role Play

  • Choose a role (provider, client, or interpreter)
  • Arrange the seating according to role
  • The interpreter shall interpret the scenario in the:
    • Consecutive mode
    • 1st person, keeping gaze low
  • Switch roles
how to effectively communicate through an interpreter thank you
How to Effectively CommunicateThrough an InterpreterThank you!

Northern Virginia AHEC