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Collaborating With Interpreters - Key Issues
Collaborating With Interpreters - Key Issues
Overview
Key Issues
Definitions
Role of Cultural and Linguistic Brokers
Roles and Responsibilities of Audiologists and SLPs
Selecting an Interpreter, Transliterator, or Translator
Collaborating With the Interpreter or Transliterator
Working With Translators
Paying for an Interpreter, Transliterator, or Translator
Service Provision
Legal and Ethical Concerns
Case Studies
Definitions
Interpreter—a person trained to convey spoken or signed communications from one language
to another. Interpretation services may be provided
in person;
by phone, such as language lines for interpreting spoken languages (e.g., French to
English);
using videoconferencing services/video interpreting platforms; and/or
using apps available via electronic devices, such as tablets, computers, and
smartphones.
Transliterator—a person trained to facilitate communication for individuals from one form to
another form of the same language. This person is most often used for individuals who are
d/Deaf or hard of hearing (D/HOH) who use oral, cued, or manual communication systems
rather than a formal sign language. Transliterators differ from interpreters in that interpreters
generally receive information in one language and interpret the information in a different
language.
Translator—a person trained to translate written text from one language to another.
Cultural Broker—a person knowledgeable about the client's/patient's culture and/or speech-
language community. The broker passes cultural/community-related information between the
client and the clinician in order to optimize services.
Appropriate roles and responsibilities of audiologists and SLPs when collaborating with an
interpreter, transliterator, or translator include the following:
It may be difficult for a clinician unfamiliar with the language to judge the quality of interpreting,
transliteration, or translation services. Clinicians must do their best to ensure that services
provided are reliable and must make every effort to become familiar with their clients'
level of proficiency in spoken English and in the language or dialect used by the
client/patient/family;
prior experience;
educational background and/or professional training; and
status of certification and/or licensure.
Employers such as school districts, courts, and health care systems may also have interpreting
aptitude tests, performance assessments, or boards that evaluate interpreters before they can
be hired. Additionally, these employers may require credentialing from a state or national
organization. A growing number of state and national associations have professional standards
and certification for trained interpreters (e.g., International Medical Interpreters Association,
Registry of Interpreters for the Deaf). Trained and/or certified professionals have codes of
ethics within their professions that they are expected to maintain. See the Registry of
Interpreters for the Deaf, National Council for Interpreters in Health Care, and America TA.
This list, arranged in approximate order of preference, does not account for the unique
variables inherent in clinical interactions.
Bilingual assistants and professional staff must consider their linguistic proficiency in both
languages being used, including their proficiency in the local dialect of the language(s) being
used by the client/patient/family and their own knowledge and skills for interpreting,
transliterating, and translating. Dialectal mismatches—such as a Spanish-speaking individual
from Mexico interpreting for a Spanish-speaking client from Spain or Argentina—may result in
inaccurate interpretations, translations, and/or cultural misunderstandings (Ostergren, 2014).
When using family members or friends in this role, the clinician considers the following factors:
Title VI of the Civil Rights Act of 1964 and the Equal Educational Opportunities Act of 1974,
public schools must ensure that English learner (EL) students can participate meaningfully and
equally in educational programs. Joint guidance from the U.S. Department of Education (ED)
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for any public schools of their legal obligation to ensure that EL students can
participate meaningfully and equally in educational programs (U.S. Department of Justice &
U.S. Department of Education, n.d.)
According to the civil rights provision of the Patient Protection and Affordable Care Act (2013),
Section 1557 expands on existing policies that prohibit discrimination based on race, color,
national origin, sex, age, or disability. Health care providers who receive federal money from
the U.S. Department of Health and Human Services must take reasonable steps to offer free,
timely oral interpretation services to people with limited English proficiency. Providers must also
provide free and timely aids and services (including sign language interpreters) for people with
disabilities, and they must provide language assistance (including translation of documents).
Providers cannot require clients to provide their own interpreters and may not rely on an adult
SIG 16's Perspectives article Working With Interpreters to Support Students Who Are English
Language Learners provides great information for how to debrief with an interpreter before and
after your session.
Introducing the clinician and the interpreter or transliterator to the client in the client's
Reviewing the client's responses, as well as the target responses, and determining if they
may have been influenced by cultural and/or linguistic variables.
Discussing any difficulties or concerns.
Dialectal differences may influence translation. To the maximum extent feasible, ensure that
documents are written in a way that is the most universally understood by speakers of different
dialects of a written language.
All vital written documentation provided to the family should be translated into the
client's/patient's/family's preferred language. Allow for sufficient time for the translator to work
with the documents.
Provide all legal documents and highly relevant materials to the translator ahead of time. In a
research setting, informed consent is presented to each human subject “in language
understandable to the subject” (Federal Policy for the Protection of Human Subjects, 2001).
Informed consent is documented in writing in most situations.
For individuals who are D/HOH, the Americans with Disabilities Act of 1990, as amended,
mandates that all public and private agencies that provide services to the general public, and
all employers with 15 or more employees, must be accessible. Therefore, the agency, service,
or business is responsible for payment for interpreting services. For students who are deaf and
have an Individualized Education Program (IEP), educational interpreting is considered a
Related Service under the Individuals with Disabilities Education Act of 2004 (IDEA). As with all
Title VI of the Civil Rights Act of 1964 mandates equal access to services regardless of
language used. Executive Order 13,166 further stipulates that agencies receiving public
funding, such as Medicaid/Medicare or IDEA funding, must provide and arrange for that access
and are responsible for the funding of an interpreter, transliterator, or translator, as needed.
Consideration is made for smaller agencies with lower annual operating budgets that may
influence the agency's ability to provide access. See guidance provided by the U.S.
Department of Health and Human Services.
At this time, third-party payers do not pay for the services of an interpreter. However, some
third-party payers and insurers may require documentation for how the non-English language
or communication system will be addressed prior to sending reimbursement.
Contracting
Clarify the party responsible for payment of interpreter, transliterator, or translator services
when providing contracted services. For example, it may be determined that it is the facility's
responsibility to provide appropriate accommodations for those services, or it may be decided
that interpretation services should be listed as a line item in the services the clinician provides.
Service Provision
The client/patient/family should be consulted to determine the mode of communication or
accommodation that is preferred and best suited to each clinical interaction. This choice may
vary depending on the type of clinical encounter (i.e., meeting, counseling, assessment,
intervention) and the needs of the setting. Consider that a client's equal access to services
encompasses the continuum from making an appointment for services, to completing
paperwork and case history forms, to participating in face-to-face meetings, to receiving written
reports, as well as interaction during assessment and intervention.
During service provision, clinical encounters with the client and family may necessitate different
types of interpreting, transliteration, and translation services.
Consecutive Interpreting—the interpreter transmits the message after a section of the source
language is produced and during a pause. The interpreted message is divided into segments of
appropriate length in order to be conveyed to the target language and be well-understood.
Compared with SI, consecutive interpreting may be more commonly used during assessment
and intervention of spoken language. Additionally, interpreters of both spoken and manually
coded languages may utilize consecutive interpretation when the client provides a great deal of
information at once in order to fully comprehend the information and then accurately convey
the meaning. Consecutive interpreting may also be preferred for clients/patients/families with
compromised cognitive abilities (Langdon, 2002).
Effective interpreting may alternate between consecutive and simultaneous, depending on the
needs of the clinical interaction and the communicative intent.
Oral Transliteration—the transliterator mouths words clearly so that people who are D/HOH
and skilled in speech reading can understand what is being said by watching the transliterator's
face, gestures, body language, and lips. Oral transliterators may choose to rephrase a
message with words that are more visible on the lips when possible. They may also "voice" for
individuals who are D/HOH (Registry of Interpreters for the Deaf, 2007).
Not all spoken and manually coded languages, including ASL, have a written form.
Technology
Technology offers opportunities for individuals to access interpretation, transliteration, and
translation services.
Technology may be used to facilitate carryover and recall of strategies and techniques.
Smartphones provide an opportunity to record spoken language and video signed languages to
allow clients/patients/caregivers to revisit clinical recommendations.
Refusal of Services
At times, clients/patients/caregivers may refuse the assistance of an interpreter/transliterator.
Clinicians consult with clients/patients/caregivers on the value of working with the assistance of
the interpreter/transliterator in order to obtain the most accurate data. A signed release
statement should be collected in cases where such services are declined.
On-Site Translation
All vital written documentation should be translated into the client's/patient's and/or family's
preferred language, and clinicians should allow sufficient time for the translator to become
familiar with these documents. Not all spoken or signed languages have written forms of
communication.
There may be times when the interpreter or transliterator is asked to also provide translation
services. However, translation requires different skills from interpreting and transliterating.
Unless the interpreter is also a translator, the clinician should not expect this. Some qualified
professional interpreters do not feel comfortable doing sight translation or written translation.
Software programs frequently look for verbatim substitutions and do not offer professional,
reliable results. Interpreting and translating is not word-for-word substitution and may require
more or fewer words to communicate an intended message as well as complete syntactic
restructuring of sentences or even full paragraphs to maintain cohesion and coherence.
Assessment
The basis of an appropriate diagnosis of a communication disorder is a reliable, valid, and
culturally and linguistically appropriate assessment. When conducting an assessment while
collaborating with an interpreter, translator, or transliterator, clinicians
Selection of appropriate assessment tools is based on the needs of the client/patient and the
presenting concerns. Currently, only a limited number of tests have been translated, and an
even smaller number of those assessments have been standardized for administration with the
collaboration of an interpreter.
Prepared or on-site translation of formal assessments that have been standardized on English-
speaking populations may provide the opportunity to gather information in a structured manner.
However, the clinician must critically evaluate the validity of the translated materials. For
example, speech sound elicitation materials may not elicit the same sounds, and allophonic
variation will differ across languages; subject omission is acceptable in Spanish but not
English, so in a sentence repetition task, take great care in how the data are used. Written
permission is to be obtained from the test publisher before test materials can be translated for
either a clinician's individual use or for dissemination of the translated version of the test for use
on a wider scale (i.e., clinical program, district, or research group). In these circumstances, it is
not appropriate to report standard scores.
Intervention
The intervention process and subsequent ongoing consultation allow for more prompting and
feedback than assessment. Effective intervention also takes the cultural significance and
relevance of goals into account. Therefore, it becomes critical for the clinician to share the
overall goals of intervention sessions with the interpreter to optimize service delivery. When
working with an interpreter or transliterator, the clinician does the following:
Considers the client's experience during the assessment process and, if possible,
collaborates with the same interpreter or transliterator from assessment through
intervention, as appropriate.
Explains to the interpreter or transliterator why and how various activities and exercises
assist the client. Providing context for an activity is often helpful in accomplishing goals.
Engagement of family members may facilitate a carryover of clinical objectives and strategies
to a functional environment that is beneficial to the client's progress. Intervention plans may
include components on how to engage the family members and how the family will support the
client in the home. The clinician considers communication preferences and
interpretation/transliteration/translation needs for family members and caregivers, as well.
Documentation
Collaboration with an interpreter, transliterator, or translator and any observations regarding the
impact of this collaboration on assessment and intervention findings should be documented in
reports and submissions for insurance claims. Use of translated materials should also be
indicated. This documentation provides an accurate record of clinical interaction and a legal
record of the services provided. It also provides evidence of ethical conduct, consistent with
Principle of Ethics I, Rules B and C (ASHA, 2016).
Executive Order 13,166 was signed in 2000 to provide guidance to federal agencies on the
enforcement of Title VI of the Civil Rights Act of 1964 as it pertains to language access. It
reminds agencies receiving federal funding that “health care organizations must offer and
provide language assistance services, including bilingual staff and interpreter services, at no
cost to each patient/consumer with limited English proficiency at all points of contact, in a timely
manner, during all hours of operation” (Youdelman, 2008, para. 6). The guidance provided
applies to any health care provider or entity that receives federal funding, including
Medicare Part A;
federally funded clinical trials;
Children's Health Insurance Program (CHIP); and
Medicaid.
The Americans with Disabilities Act of 1990 prohibits discrimination and ensures equal
opportunity for persons with disabilities in the areas of employment, state and local government
services, public accommodations, commercial facilities, and transportation. Congress has
mandated the need for auxiliary aids and services—such as interpreters, transliterators, and
translators—to ensure equal opportunity for individuals with disabilities (Americans with
Disabilities Act of 1990). A language difference alone is not a disability. To confirm compliance,
consult ADA's Checklist for General Effective Communication.
The Equal Educational Opportunities Act of 1974 states, “All children enrolled in public schools
are entitled to equal educational opportunity without regard to race, color, sex, or national
origin.” No state can deny students the right to equal education by “failure by an educational
For school-age children, the Individuals with Disabilities Education Act of 1990 (IDEA) was
enacted to ensure that all children with disabilities (age 3–21) have available to them a free and
appropriate public education (FAPE) that emphasizes special education and related services
designed to meet their unique needs and prepare them for further education, employment, and
independent living.
Part B
IDEA states that, in the development, review, and revision of an IEP, the team must consider
several factors with regards to interpreters:
(iv) Consider the communication needs of the child, and in the case of the child who is
D/HOH, consider the language and communication needs, opportunities for direct
communication with peers and professionals in the child's language and communication
mode, academic level, and full range of needs including opportunities for direct instruction
in the child's language and communication mode, and (v) Consider whether the child
requires assistive communication devices and services. [IDEA § 1414(d)(3)(B)]
Parents and IEP teams assign or hire an interpreter on the basis of the child's mode of
communication. Specifically,
[i]nterpreting services, as used with respect to children who are deaf or hard of hearing,
includes oral transliteration services, cued language transliteration services, and sign
language interpreting services. [IDEA, 34 C.F.R. 300.34(c)(4)]
Services for children who are learning English as a second language must take the
language(s) of the home into consideration for both assessment and intervention. For children
who receive services with an IEP under Part B (age 3–21), “When evaluating English language
Part C
For children who receive services with an Individualized Family Service Plan (IFSP) under Part
C (birth–2):
Language added to §§ 303.321(a)(5) and 303.321(a)(6) states that all evaluations and
assessments of a child must be conducted in the native language of the child, in
accordance with the definition of native language in § 303.25, unless clearly not feasible
to do so. While the phrase ‘unless clearly not feasible to do so' was inserted to
acknowledge that there may be instances where conducting an assessment in the child's
native language is not possible, the U.S. Department of Education, in the discussion
section of the final regulations, clarifies that best efforts should be put forth to locate an
on-site or telephonic interpreter when needed. (ASHA, n.d.-b)
Native language, as defined in § 303.25(a)(1) of IDEA, means “the language normally used by
that individual, or in the case of a child, the language normally used by the parents of the child.”
HIPAA
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides national
standards to protect the privacy of personal health information. Some regulations include
provisions related to service providers working with interpreters, transliterators, and translators.
HIPAA allows covered health care providers to share a client/patient's health information with
an interpreter without the patient's written authorization under the following circumstances:
A health care provider may share information with an interpreter (e.g., a bilingual
employee, a contract interpreter on staff, or a volunteer) who works for the provider.
A health care provider may share information with an interpreter who is acting on its
The National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health
and Health Care (Office of Minority Health, n.d.) are intended to advance health equity, improve
quality, and help eliminate health care disparities by providing a blueprint for individuals and
health care organizations to implement culturally and linguistically appropriate services.
Although these guidelines are not federal law, they are recommended by the U.S. Department
of Health and Human Services, Office of Minority Health. With regards to communications and
language assistance, the CLAS standards seek to
offer language assistance to individuals who have limited English proficiency and/or other
communication needs, at no cost to them, to facilitate timely access to all health care and
services;
clearly inform all individuals of the availability of language assistance services in their
preferred language, verbally and in writing;
ensure the competence of individuals providing language assistance, recognizing that the
use of untrained individuals and/or minors as interpreters should be avoided; and
provide easy-to-understand print and multimedia materials and signage in the languages
Ethics
ASHA's Code of Ethics (2016) provides the fundamentals of ethical conduct. Principles of
Ethics and Rules of Ethics are specific statements of minimally acceptable as well as
unacceptable professional conduct—and are applicable to all individuals who are ASHA
members and/or certificate holders or who are applicants for membership and/or certification.
Although providing services to linguistically diverse individuals may require the assistance
of trained interpreters or other bilingual professionals, it is the responsibility of the
professional to understand the influence of issues related to cultural and linguistic diversity
(e.g., second language acquisition, dialectal differences, bilingualism). Ultimately, the
professional is responsible for the appropriate diagnosis and treatment/management of
communication disorders, as well as of swallowing and balance disorders. (ASHA, 2017,
Guidance section, Principle of Ethics I, Rule F, para 3)
Several provisions within the Code apply to working with individuals who use a language other
than spoken English, including:
Periodically, the Board of Ethics develops Issues in Ethics Statements when further clarification
and guidance are needed to assist in ethical service delivery. The Issues in Ethics statement,
Cultural and Linguistic Competence , specifically addresses the use of interpreters for the
provision of services (ASHA, 2017).
Case Studies
Case studies may serve to illustrate the complex decision-making process, as clinicians strive
to provide the most appropriate services to individuals who do not use spoken English in the
home.
Discussion
The administrators of Head Start programs are legally responsible for ensuring the appropriate
provision of services per Title VI of the Civil Rights Act of 1964. Given that the SLP is
monolingual, adherence to the law would call for working with the assistance of an interpreter.
The law does not specify the training and/or qualifications of the interpreter. ASHA's Principle of
Ethics I, Rule B, states, “Individuals shall use every resource, including referral and/or
interprofessional collaboration when appropriate, to ensure that quality service is provided.” In
order to ensure that they are meeting this requirement, the SLP may do two things: (1) seek out
a trained interpreter or (2) provide training to the bilingual assistant to ensure high-quality
services.
Case Study 2
A clinician's supervisor asks him to evaluate a Cantonese-speaking 7-year-old girl. The girl's
family came from China. No Cantonese-speaking SLP is available in the district, so the clinician
evaluates her through an interpreter. This interpreter knows the dialect spoken by the child and
A few days after the clinician submits his evaluation, he receives a phone call. His district has
rejected his evaluation because test scores have not been not reported. He explains that
translated tests are invalid because they do not take into account differences between the two
languages. He also explains that the assessment procedures he followed provide an
appropriate assessment of the child's communication skills.
His district supervisor, however, reminds him that, up until this point, he and every other SLP in
the district have provided test scores. These scores, the district supervisor explains, were an
easy way to see a child's level of performance to determine eligibility for services. So, the
clinician must go back, retest the child using a translated test, and report those test scores.
The ethical dilemma: Does the clinician go back with his interpreter, have her translate the
tests, and then determine eligibility based upon the child's scores?
Discussion
According to IDEA, there is a need to demonstrate academic impact and the absence or
presence of a disability. A number of different measures may be used. There are no legal
requirements that standard scores must be used to qualify an individual to receive services.
Principle of Ethics II indicates that “Individuals shall honor their responsibility to achieve and
maintain the highest level of professional competence and performance” (ASHA, 2016). The
clinician would not be honoring this responsibility if they knowingly uses standard scores from a
translated version of an assessment that has not been validated on a population representative
of the individual tested
Case Study 3
Discussion
Legally, all materials must be presented to the patient in their preferred language. In addition to
legal requirements, the Joint Commission requires that patient intake forms request preferred
language. Signed languages and manual communication systems do not have a written
language component. English is often the presumed form of preferred written language;
however, it may not be. It may be necessary to supplement written documentation with a cued
speech transliterator in order to ensure comprehension. To ensure the best mode of
communication, the preferred written language should be requested.
Case Study 4
A child who speaks Russian in the home exclusively is referred to an SLP. An interpreter was
provided for the assessment, and the SLP determined that the child has a language disorder.
The school administration and teachers want the SLP to provide intervention services in
English only—because that is the language of the school. The SLP has concerns that this will
not be sufficient to address the child's needs. What is the most ethical thing to do moving
forward?
Discussion
IDEA states that the language of intervention should be the language most likely to yield the
most accurate results. Although English is the language of the school in most cases, the
language disorders of children who do not speak English can best be remediated in a language
that they are familiar with. Executive Order 13,166 (2000) stipulates that agencies receiving
public funding provide equal access to services regardless of language spoken. It is important
that the SLP advocate for the most appropriate resources required to work with this child.
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