(Sight translation by Certified Deaf Interpreter Mistie Owens)
Guest blogger Kalen Beck, CI, CT, is a Senior Consultant for Critical Measures with more than 25 years of language access expertise in the healthcare field as a certified interpreter, director of language operations and as an executive within an academic medical center.
Last week I had the opportunity to participate in an incredibly well-attended webinar, “Video Remote Interpreting for Deaf and HOH Patients: Finding Balance in the Midst of Controversy.” In this webinar we explored why video remote interpreting (VRI) has been such a controversial topic for Deaf and hard of hearing (HOH) patients and what is being done to strike a balance in the midst of the controversy.
The webinar featured a diverse group of panelists, including Mistie Owens, a Certified Deaf Interpreter (CDI), who kicked it off by sharing her perspective of using VRI in the healthcare setting and a brief history of the Deaf Community. David Hunt, President and CEO of Critical Measures, provided the legal perspective on the use of VRI in medical settings and Debbie Lesser, Director, ASL Services & Learning Development for InDemand Interpreting, shared the benefits of using InDemand VRI. I had the chance to offer the operational perspective of serving Deaf and Hard of Hearing patients within a healthcare setting.
Understanding the Landscape
There are varying views of the use of VRI within the healthcare setting:
- The legal perspective
- The National Association of the Deaf (NAD) perspective and
- The Registry of Interpreters for the Deaf (RID) perspective.
In our discussion, David Hunt shared the legal obligation for healthcare providers when it comes to language access. “Healthcare providers have a duty to provide auxiliary aids and services for people who are Deaf or have a hearing loss. Such aids and services enable the healthcare provider to communicate as effectively with people who are Deaf and hearing impaired as with people who do not have these disabilities. C.F.R. §36.303(c)"
Even though the law clearly states that providers have the last word in deeming a modality appropriate for patients, interpreters and the Deaf community do not always agree.
National Association of the Deaf Perspective
It is the position of the NAD that the use of on-site interpreters should always be paramount and when VRI is used in the absence of any available on-site interpreter, it must be used properly in terms of policy, procedure and technology. Failure to conform to these standards is not only a failure to ensure effective communication under federal law but also creates unnecessary risks to the medical welfare and health care of deaf individuals.
- VRI is only for “filling in the gap” of on-site services and should only be used when on-site is not available and limited use in other encounters
- NAD does not support or endorse any particular VRI technology, but is more concerned if it works effectively and whether or not the staff know how to operate the equipment.
- And lastly, NAD feels that Deaf patients know what communication aids work best to achieve “effective communication.” NAD also asserts that hospitals MUST consider the patient’s preference before choosing a mode of commun
Registry of Interpreters for the Deaf Perspective
RID is a national membership organization that advocates for interpreting services between people who use sign language and people who use spoken language and is also the accrediting body for national certifications. In 2010, RID published a standard practice paper on interpreters working in video remote settings. This paper was created from the perspective of the interpreter and was designed to serve as an educational tool for hiring interpreters to work in VRI settings as well as for organizations who were starting to use VRI to serve their patients.
- RID states that if the remote interpreter determines a situation is not appropriate for VRI, an on-site interpreter should be provided. If any of the participants believe that VRI is not effective, then the parties need to arrange for an on-site interpreter. This could include providing a remote or on-site CDI to work collaboratively with either a remote or on-site hearing interpreter.
Determining the Most Effective Modality
Now that we have an understanding of the varying perspectives on VRI, it’s important to consider which encounters are generally more appropriate for on-site communication and which encounters might be better suited for VRI.
- Lengthy and complex medical settings. These are encounters where the time needed for an interpreter is greater than a short consult. For example: surgeries, procedures, patient education where demonstration or patient interaction is crucial such as a birthing class.
- Physical or emotional barriers exists. These are not just disability barriers such as Deaf/Blind patients who can’t see the VRI screen, but also if a patient presents with a broken arm or any patients who may be in a prone position. Is the patient strapped to a backboard and are unable to see the VRI screen?
- Highly emotional encounters, initial diagnosis or hospice discussions. We know patients in these circumstances can be at their most vulnerable. This is the time to ensure they have someone in the room who not only can “speak their language” but understands from a cultural view the impact of the discussion on their lives. If an on-site interpreter is absolutely not available, VRI could be effective if the encounter is teamed with an on-site Certified Deaf Interpreter (CDI)
- High risk procedures with possible adverse reaction. For example, cardiac catheters or a visual field exam would be more appropriate for on-site interpreters
There are times when on-site is not the best choice and a VRI interpreter would make more sense for a particular encounter. For example:
- Safety could be compromised. If a patient may be apt to erupt in violent behavior, keeping the safety of all involved is key and a remote interpreter is one less person in the room and in harm’s way.
- Confidentiality risk. Patients with sensitive conditions that could affect their standing in the local community. For example, a Deaf patient may choose to have elective plastic surgery and not want their local community to know.
- Reputation risk. Similarly, to the confidentiality risk, a Deaf patient may have ostracized themselves from the local interpreting community. One example was a Deaf gentleman who was notorious for flashing interpreters. Local interpreters began refusing to work with him and yet the hospital still has the burden to provide effective communication.
- At point of entries into the healthcare system. When patients present to the emergency room or walk-in clinic, there is a sense of urgency and immediate need access communication.
- Lack of access to qualified interpreters – If the number of medically trained, certified interpreters is limited, it would be better to use a qualified and certified VRI interpreter rather than an inexperienced, non-certified interpreter.
Don’t Forget about Hard of Hearing Patients
With the baby-boomer population aging into hearing loss, Hard of Hearing patients, who do not use ASL as their primary mode of communication, may require other modes to communicate. These auxiliary aides could include captioning services such as communication access real time translation (CART), pocket talkers (used to amplify the provider’s voice) and neck loops which can be used with hearing aids through a T-coil.
Some of these individuals may also rely on lip reading and/or writing notes. While lip reading and writing notes are not generally an effective form of communication for individuals who use ASL, it may be a preferred way of communication for patients who are late deafened or have aged into hearing loss. Utilizing some of the other resources mentioned, may be new for your patients and could ensure better, effective communication for everyone involved.