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Here are some examples of interpretation and translation services and cultural diversity training that a rehabilitation facility might employ:
• In-person interpretation by a professional. Among the most costly of interpretation services, this sometimes is the best solution. The interpreter, usually contracting with the facility through an interpretation service, will meet with the patient and health care provider during regular or emergency medical sessions.
For example, interpreters from Phoenix Language Services in Huntington Valley, PA, often meet with rehab patients and therapists for each of the first few 45-minute to 1-hour sessions, because that’s when most of the therapy information is being given, says Bill Martin, the agency’s executive director. "To make it cost-effective, we might not have the interpreter go there during every session," Martin explains. "The interpreter becomes an important part of the patient’s therapy because the patient identifies more with the interpreter than with the therapist."
Other instances when it might be better to have an interpreter present are when it’s the patient’s first time in the hospital and when the physician has bad medical news for the patient, says Cindy Roat, MPH, a quality assurance specialist for Pacific Interpreters in Portland, OR, and the executive director of Pacific Language Consultants. Roat also is the co-chair of the Board of the National Council on Interpretation in Health Care, also in Portland.
The chief advantages to using a contract interpreter service rather than staff are that such services typically train interpreters in cultural issues that might affect a patient’s health care. Another advantage is that these services have access to interpreters of dozens of languages, so that when a facility admits a patient who speaks an African tribal language or a certain Chinese dialect, then the service likely can provide help.
• Telephonic interpretation services. Interpreter services provided over a telephone may be useful when a rehab facility is located in a rural or suburban area where professional interpreters are not available or when the patient needs emergency care and there is not enough time for an interpreter to arrive on the scene.
Telephonic interpretation services also are a less costly alternative to in-person interpretation. Because there are more competitors providing this service, the costs have declined, Roat says. "There’s a lot of discussion within the industry about when it’s better to use on-site and when it’s better to use telephonic interpretation services," Roat says. "There is an agreement that sometimes telephonic is the best choice."
For example, if a clinician needs to call a patient at home, then the clinician could easily have an interpreter connected to the call. Also, if a rehab facility’s interpreter service does not have anyone who can speak a particular patient’s language, then the facility could call a national interpretation company and use its telephonic service, Roat says.
Examples of when telephonic interpretation might not work well include when a patient is hard of hearing or when patients come from a cultural background in which telephones are not used, Roat explains. "A lot of elderly patients come from parts of the world where they didn’t use a telephone until they were adults, and they may find it harder to receive health care over a telephone."
Telephonic interpretation services could be provided through headsets or telephones that are set up for a conference call in which the clinician, the patient, and the interpreter are all connected to the same line, or they could be conducted through a single telephone line that is shared and passed between the clinician and the patient. The latter scenario is not ideal, Roat says. "Passing a telephone back and forth between patient and clinician forces the interpreter into the role of mediator, and that’s not a good thing," Roat says.
The best method is remote simultaneous interpretation, which is similar to what the United Nations uses, Roat says. With this method, the patient and the clinician each have a headset telephone that communicates directly with the interpreter. As the clinician speaks, the interpreter simultaneously interprets for the patient, and the reverse happens when the patient speaks.
• Translation services. Crozer-Keystone Health System in Upland, PA, provides a variety of translation services to patients. For example, numerous clinical documents have been translated into Spanish, and some signs will be translated into Vietnamese for one of the system’s hospitals.
Crozer-Keystone staff also may use interpretation cards describing access procedures and language cards that provide basic communication between patients and staff. The language cards display translations from 11 languages. The foreign words printed on the cards are spelled phonetically so staff can more easily pronounce the words, says Bonnie Breitt, OTR, MHSA, administrative director of rehabilitation services for four Crozer-Keystone hospitals. The language card messages ask patients about pain or whether they’re hungry, Breitt adds.
• Cultural diversity training/conferences. Crozer-Keystone staff are educated about the importance of using an interpreter and about the kinds of problems that occur when a clinician fails to call for an interpreter. They also are told about some specific cultural beliefs among patients from different ethnic and religious backgrounds, Breitt says.
At Delaware County Memorial Hospital in Upper Darby, PA, there is an Asian Awareness Day, in which management selects a particular Asian culture to highlight. Staff are taught about the culture’s food and activities. At other Crozer-Keystone hospitals, the staff celebrate Black History Month, and the rehab staff create an educational program including posters, listings of area museums with information about black history, and information about African-American food, Breitt says. "I think it’s important in rehab that we look to the needs of the person being served," Breitt says, adding that these needs include the need to be fully understood by health care providers.