In Person and Video In Person and Video Remote InterpretingRemote Interpreting

Know your FactsKnow your Facts

Presented byPresented by

Rachel SpillaneRachel Spillane

M.Ed., CSC, OTCM.Ed., CSC, OTC

Director of Deaf Out Reach Director of Deaf Out Reach ServicesServices

Interpretation MethodsInterpretation Methods

Can be done by Face to Face (in person)Can be done by Face to Face (in person) Can be done thru video remote Can be done thru video remote Can be done by phoneCan be done by phone Can be written translationCan be written translation

Video Remote EquipmentVideo Remote Equipment

Equipment and installation requirementsEquipment and installation requirements

Steps of the VRI SystemSteps of the VRI SystemStep One: The hospital personnel phones the VRI agency to request the VRI service

Step Two: The agency then contacts the VRI interpreter with the request

Step Three: The VRI interpreter places the call to the hospital contact person to ensure the equipment is in place and is ready to be used

Step Four: The Interpreter then initiates the VRI connection

The Difference between The Difference between VRS & VRIVRS & VRI

VRSVRSPhone Relay ServicePhone Relay Service

Controlled by FCCControlled by FCC

Can only be located in Can only be located in approved Centersapproved Centers

VRIVRIVideo to Video ServiceVideo to Video Service

No Controls, just No Controls, just partnership agreementpartnership agreement

Can be located in Can be located in Interpreter’s home and Interpreter’s home and follows HIPAA/RID follows HIPAA/RID confidentiality confidentiality guidelinesguidelines

The Difference between The Difference between VRS & VRI VRS & VRI (continued)(continued)

VRSVRS

Variety of TopicsVariety of Topics

Qualified Interpreters, Qualified Interpreters, does not mean certified does not mean certified or trained to cover all or trained to cover all topic matterstopic matters

VRIVRI

Specialized TopicsSpecialized Topics

Interpreters should be Interpreters should be RID Certified and had RID Certified and had specialized training i.e. specialized training i.e. MedicalMedical

Demand vs SupplyDemand vs Supply

The Sign Language interpreter pool is facing a The Sign Language interpreter pool is facing a shortage, in some areas of the country it is shortage, in some areas of the country it is severe.severe.

The shortage is due to the following reasons: The shortage is due to the following reasons: Advent of VRS (Video Relay Services) , Advent of VRS (Video Relay Services) , dwindling numbers from training programs, the dwindling numbers from training programs, the largest pool of interpreters are nearing largest pool of interpreters are nearing retirement , demand from business and retirement , demand from business and educational settings have increased etc.educational settings have increased etc.

Embarking on Video Remote Embarking on Video Remote BusinessBusiness

Consider equipment needs: connectivityConsider equipment needs: connectivity How to man the systemHow to man the system Where to place the end point systems i.e. in Where to place the end point systems i.e. in

centers vs interpreters homescenters vs interpreters homes Cost of running this type of systemCost of running this type of system Training Hospital Staff, deaf patients and Training Hospital Staff, deaf patients and

interpretersinterpreters Consider Federal, State regulations, guidelinesConsider Federal, State regulations, guidelines

Cost of running VRICost of running VRI Over head costs: of hook up, T1 lines, phone lines, gate Over head costs: of hook up, T1 lines, phone lines, gate

keeper, border control , paying 3 shift employees keeper, border control , paying 3 shift employees salariessalaries

Billing costsBilling costs Equipment costs: average cost of small VRI unit is Equipment costs: average cost of small VRI unit is

anywhere from $2500 and upanywhere from $2500 and up Average yearly cost of running this type of business with Average yearly cost of running this type of business with

bare bones staffing is about $200,000 per year. bare bones staffing is about $200,000 per year. With 7 hospitals on, this is volume based business you With 7 hospitals on, this is volume based business you

would see of an average of $1500 a monthwould see of an average of $1500 a month Most major VRI companies will tell you that they were in Most major VRI companies will tell you that they were in

the red for more than 5 years before they saw a profit. the red for more than 5 years before they saw a profit. Again this is volume based businessAgain this is volume based business

Importance of Developing Training Importance of Developing Training MaterialsMaterials

Hospitals need to know how to appropriately use Hospitals need to know how to appropriately use interpreting servicesinterpreting services

Must develop training materials that is Must develop training materials that is accessible and easy to implement i.e Power accessible and easy to implement i.e Power Point Presentation on hospital computer system Point Presentation on hospital computer system for on going training, pamphlet (1 page) that is in for on going training, pamphlet (1 page) that is in accessible location for staffaccessible location for staff

Must physically go to the hospitals on a periodic Must physically go to the hospitals on a periodic basis to present the power point training due to basis to present the power point training due to staff turnover and if staff hasn’t had the staff turnover and if staff hasn’t had the experience of requiring interpreting services experience of requiring interpreting services (Reinforcement is Key)(Reinforcement is Key)

Possible Possible Inappropriate Inappropriate VRI SituationsVRI Situations

TechnicalTechnical

DifficultiesDifficulties

Visual BarriersVisual Barriers Cognitive Cognitive BarriersBarriers

VRI GuidelinesVRI Guidelines

•Technical DifficultiesTechnical Difficulties VRI clarity is based on type of connection, if it is based on VRI clarity is based on type of connection, if it is based on

equipment use overall in a hospital, a power drain will equipment use overall in a hospital, a power drain will produce a poor quality picture. Sometimes the picture will produce a poor quality picture. Sometimes the picture will freeze up. The Interpreter will have to disconnect and freeze up. The Interpreter will have to disconnect and reconnect. This may happen several times during a reconnect. This may happen several times during a session.session.

If the settings on the VRI have been changed inadvertently If the settings on the VRI have been changed inadvertently you will receive no picture. Troubleshooting has to occur you will receive no picture. Troubleshooting has to occur here to get the appropriate settinghere to get the appropriate setting

If VRI is wireless, there could be dead zones in the hospital If VRI is wireless, there could be dead zones in the hospital where the VRI will not work at all. similar to cell phone where the VRI will not work at all. similar to cell phone problems.problems.

Power outage or equipment failure can occurPower outage or equipment failure can occur If troubleshooting takes more than 10 minutes, the hospital If troubleshooting takes more than 10 minutes, the hospital

should call for an on site interpretershould call for an on site interpreter

Visual BarriersVisual Barriers

If there is too much equipment in a room or the If there is too much equipment in a room or the equipment will interfere with the use of the VRI. equipment will interfere with the use of the VRI. The VRI should not be used. An example of this The VRI should not be used. An example of this would be eye exam. The exam takes place in a would be eye exam. The exam takes place in a dark room with a lot of equipment. The dark room with a lot of equipment. The equipment is a barrier for the deaf consumer to equipment is a barrier for the deaf consumer to even see the VRI interpreter. Another example even see the VRI interpreter. Another example would be hearing test. The room is lead would be hearing test. The room is lead shielded and prevents wireless connection to the shielded and prevents wireless connection to the VRI unit.VRI unit.

Visual BarriersVisual Barriers

Deaf consumer has vision loss that will Deaf consumer has vision loss that will prevent the person from using the VRI. prevent the person from using the VRI.

Cognitive BarriersCognitive Barriers

If the Deaf consumer has cognitive If the Deaf consumer has cognitive impairment due to alcohol/drug, or is on impairment due to alcohol/drug, or is on medication that impairs judgment, has TBI, medication that impairs judgment, has TBI, Senility, Alzheimer, and mental illness. Senility, Alzheimer, and mental illness. VRI should not be used under these VRI should not be used under these circumstances.circumstances.

Decision to use VRI or not to use Decision to use VRI or not to use VRIVRI

The hospital personnel should always The hospital personnel should always explain fully to the deaf patient when explain fully to the deaf patient when making a medical appointment about the making a medical appointment about the interpreting service options. The final interpreting service options. The final decision of how the communication is to decision of how the communication is to be handled should always be left to the be handled should always be left to the deaf person. VRI should never be forced deaf person. VRI should never be forced on a deaf patient.on a deaf patient.

The next few slides are The next few slides are examples of what to include in a examples of what to include in a

training power point to the training power point to the hospital staffhospital staff

Situations where the VRI is Situations where the VRI is appropriateappropriate

Emergency Room-admissions information for triage to Emergency Room-admissions information for triage to formulate treatment planformulate treatment plan

Pre-OP, to explain procedure and to fill out hospital Pre-OP, to explain procedure and to fill out hospital questionnaire, consent form etcquestionnaire, consent form etc

Prior to a routine procedure i.e. x-ray, MRI,CATSCAN, Prior to a routine procedure i.e. x-ray, MRI,CATSCAN, Physical Therapy etcPhysical Therapy etc

Short routine office visit (less than ½ hr)Short routine office visit (less than ½ hr) Doctor’s roundsDoctor’s rounds When medical staff needs to talk to a patient who is When medical staff needs to talk to a patient who is

hospitalized for an update on patient’s status hospitalized for an update on patient’s status Discharge planningDischarge planning

Situations where VRI Situations where VRI should not be usedshould not be used

Post operationPost operation Equipment barriers (lead shielded rooms etc)Equipment barriers (lead shielded rooms etc) Patient is not coherentPatient is not coherent Patient’s ability to use the VRI or patient’s Patient’s ability to use the VRI or patient’s

personal preference to have on site interpreterpersonal preference to have on site interpreter Emotionally Sensitive informationEmotionally Sensitive information Complicated and Risky ProceduresComplicated and Risky Procedures Certain Mental Health situations i.e. patient is in Certain Mental Health situations i.e. patient is in

restraints etc.restraints etc.

Mental Health Mental Health

If the patient is comfortable with using the VRI If the patient is comfortable with using the VRI for mental health status, one on one counseling for mental health status, one on one counseling etcetc

In groups, you have to consider the all the In groups, you have to consider the all the participants. This is probably not a good venue participants. This is probably not a good venue for the VRI. The other issue is the ability to hear for the VRI. The other issue is the ability to hear who is speaking and this could pose a problemwho is speaking and this could pose a problem

If patient is in restraints or out of control, having If patient is in restraints or out of control, having auditory and/or visual hallucinations then the auditory and/or visual hallucinations then the VRI is not appropriateVRI is not appropriate

What the medical staff needs to know in What the medical staff needs to know in order to facilitate communication through order to facilitate communication through

the VRIthe VRI

~Always direct your comments to the deaf ~Always direct your comments to the deaf patient DIRECTLY. Stand next to the VRIpatient DIRECTLY. Stand next to the VRI so patient can see you and the interpreter so patient can see you and the interpreter

~~Be aware that everything that is Be aware that everything that is heard or seen by the interpreter will be interpretedheard or seen by the interpreter will be interpreted

~Give the Interpreter time to explain what is going to ~Give the Interpreter time to explain what is going to occur before you proceed with an action (i.e. occur before you proceed with an action (i.e. insert the needle into the patient’s arm)insert the needle into the patient’s arm)

What you need to knowWhat you need to know

Remember not to block the patient’s view Remember not to block the patient’s view of the interpreter and vice versaof the interpreter and vice versa

If you leave the room and plan on not If you leave the room and plan on not returning for a while, inform the VRI returning for a while, inform the VRI interpreter so they can disconnect and interpreter so they can disconnect and make arrangements for a reconnection at make arrangements for a reconnection at the appropriate timethe appropriate time

Privacy GuidelinesPrivacy GuidelinesIf the patient is If the patient is notnot in a private room the in a private room the

following steps will need to be taken:following steps will need to be taken:

1. Make sure the volume on the VRI unit is turned 1. Make sure the volume on the VRI unit is turned down so other people not associated with the down so other people not associated with the patient cannot hear what is being saidpatient cannot hear what is being said

2. Make sure the VRI unit is not visible to others not 2. Make sure the VRI unit is not visible to others not associated with the patientassociated with the patient

3. Limit the amount of information that needs to be 3. Limit the amount of information that needs to be stated at that point in time, until patient can be stated at that point in time, until patient can be moved to a more private locationmoved to a more private location

Advantages of VRIAdvantages of VRI

Interpreters on DemandInterpreters on Demand Access to important information immediately for quick Access to important information immediately for quick

responseresponse Better use of resources (a VRI interpreter can cover Better use of resources (a VRI interpreter can cover

more assignments in one day than an interpreter who more assignments in one day than an interpreter who drives from assignment to assignment)drives from assignment to assignment)

Pay for only the real interpreting time not the driving or Pay for only the real interpreting time not the driving or down timedown time

Interpreter is not exposed to hazardous conditionsInterpreter is not exposed to hazardous conditions Can be a cost savings if used efficientlyCan be a cost savings if used efficiently Complies with the ADA legislationComplies with the ADA legislation

The following slides are The following slides are examples of what you would use examples of what you would use

to train your interpreting staffto train your interpreting staff

The Interpreting ChallengeThe Interpreting Challenge

Medical Terminology Interpretation Medical Terminology Interpretation Language Equivalents (expansions) Language Equivalents (expansions) Working in 2 dimensional environment has an impact on Working in 2 dimensional environment has an impact on

certain visual cuescertain visual cues TeamingTeaming The interpreter has to make sure the lighting, contrast The interpreter has to make sure the lighting, contrast

and visibility is clear enough on both endsand visibility is clear enough on both ends The interpreter has to be aware and notify if picture The interpreter has to be aware and notify if picture

quality starts to disintegratequality starts to disintegrate The interpreter has to be aware and notify if audio levels The interpreter has to be aware and notify if audio levels

are compromisedare compromised

VRI Teaming with CDIVRI Teaming with CDI

Certain patients have a compromised Certain patients have a compromised communication issue and will need a deaf communication issue and will need a deaf interpreter along with the hearing interpreter along with the hearing interpreterinterpreter

A CDI will be on site and will use the VRI A CDI will be on site and will use the VRI Interpreter to relay the message to the Interpreter to relay the message to the patientpatient

VRI Teaming with CDIVRI Teaming with CDI

The VRI Interpreter along with the CDI The VRI Interpreter along with the CDI interpreter will control the communication interpreter will control the communication traffic to make sure the CDI has plenty of traffic to make sure the CDI has plenty of time to convey the messagetime to convey the message

The patient will not be viewing the VRI The patient will not be viewing the VRI Screen, only the deaf interpreter will be Screen, only the deaf interpreter will be viewing the screenviewing the screen

VRI Teaming with CDIVRI Teaming with CDI

The patient will be in direct communication The patient will be in direct communication line with the CDIline with the CDI

Medical staff has to be aware not to block Medical staff has to be aware not to block visual communication either by standing or visual communication either by standing or putting equipment in front of the sightlines putting equipment in front of the sightlines of the interpreters and the deaf patientof the interpreters and the deaf patient

VRI Teaming with CDIVRI Teaming with CDI

Technology is also available where both Technology is also available where both the CDI and the hearing interpreter will be the CDI and the hearing interpreter will be on the VRI screen, in that case, the VRI on the VRI screen, in that case, the VRI screen will be facing the deaf patient and screen will be facing the deaf patient and all other information listed above will still all other information listed above will still holdhold

CDI ResponsibilitiesCDI Responsibilities

CDI needs to be aware of environmental CDI needs to be aware of environmental information that needs to be passed onto the information that needs to be passed onto the VRI InterpreterVRI Interpreter

CDI needs to be aware to pass on visual cues in CDI needs to be aware to pass on visual cues in a subtle way as to not offend the deaf patienta subtle way as to not offend the deaf patient

When the VRI is turned off, the CDI should leave When the VRI is turned off, the CDI should leave the room and establish a way for the medical the room and establish a way for the medical staff to alert the CDI when interpreting needs staff to alert the CDI when interpreting needs arisearise

CDICDI

CDI in a mental health setting need to be CDI in a mental health setting need to be aware of their signing affect so as not to aware of their signing affect so as not to increase the patient’s anxiety or emotional increase the patient’s anxiety or emotional statestate

CDI can determine if an onsite hearing CDI can determine if an onsite hearing interpreter would be better suited for the interpreter would be better suited for the situation at handsituation at hand

CDICDI

CDI and VRI interpreters don’t have a way CDI and VRI interpreters don’t have a way at the end of the session to talk about the at the end of the session to talk about the teaming aspect of their work, so another teaming aspect of their work, so another method has to be utilizedmethod has to be utilized

CDI have to understand how CDI have to understand how

to work in a 2 dimensional to work in a 2 dimensional frameworkframework

Clear CommunicationClear Communication

Roles clearly definedRoles clearly defined RespectRespect Effective Teaming (medical staff, VRI, CDI Effective Teaming (medical staff, VRI, CDI

and patientand patient Eliminating barriersEliminating barriers VRI should never be forced upon a deaf VRI should never be forced upon a deaf

patient even though it is stated that it patient even though it is stated that it complies with ADA (lawsuits have been complies with ADA (lawsuits have been filed in this arena)filed in this arena)

The following slides give examples The following slides give examples of how you train and empower of how you train and empower

your consumers i.e Deaf Patientsyour consumers i.e Deaf Patients

Take Charge of your Take Charge of your Communication ProcessCommunication Process

• When you make a medical appointment, ask When you make a medical appointment, ask whether you will be getting an on-site interpreter whether you will be getting an on-site interpreter or VRI. This is the time to make your preference or VRI. This is the time to make your preference known.known.

• If you are not satisfied with how the If you are not satisfied with how the communication is conducted (whether it is VRI communication is conducted (whether it is VRI or on-site interpreting), ask to speak to the or on-site interpreting), ask to speak to the Patient Relations Dept. or Nursing Supervisor.Patient Relations Dept. or Nursing Supervisor.

• If unable to resolve the issue, you can file a If unable to resolve the issue, you can file a complaint with OPA (Office of Protection and complaint with OPA (Office of Protection and Advocacy)Advocacy)

Ask the VRI interpreter the following Ask the VRI interpreter the following questions:questions:

A) What is interpreter’s name and what A) What is interpreter’s name and what company do they work for? company do they work for?

B) What is their certification level? B) What is their certification level? C) Has the interpreter had prior medical C) Has the interpreter had prior medical

interpreter training?interpreter training?D) Is the picture and sound quality clearD) Is the picture and sound quality clear

How to Advocate for yourselfHow to Advocate for yourself

Ask the VRI Interpreter the following Ask the VRI Interpreter the following questions (continued)questions (continued)

E) Do you understand the interpreter and E) Do you understand the interpreter and does the interpreter understand you?does the interpreter understand you?

F) Is VRI appropriate for your situation?F) Is VRI appropriate for your situation?

Questions and Answer PeriodQuestions and Answer Period

Thank you for attending and hopefully this Thank you for attending and hopefully this workshop gives you a plan to implement workshop gives you a plan to implement clear communication on how to effectively clear communication on how to effectively use interpreting servicesuse interpreting services