Beyond Word-for-Word Interpreting When seeking language-translation services, consider what you’re truly seeking (literal translation may not be most effective) and think local. Features
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Features  |   November 01, 2017
Beyond Word-for-Word Interpreting
Author Notes
  • Phillip Guillory, MS, CCC-SLP, NIC, is a bilingual provider and certified ASL/English interpreter specializing in medical, community and post-secondary settings. Based in Albuquerque, New Mexico, he is an affiliate of ASHA Special Interest Groups 2, Neurogenic Communication Disorders; 13, Swallowing and Swallowing Disorders (Dysphagia); 14, Cultural and Linguistic Diversity; and 15, Gerontology. phillip.guillory@gmail.com
    Phillip Guillory, MS, CCC-SLP, NIC, is a bilingual provider and certified ASL/English interpreter specializing in medical, community and post-secondary settings. Based in Albuquerque, New Mexico, he is an affiliate of ASHA Special Interest Groups 2, Neurogenic Communication Disorders; 13, Swallowing and Swallowing Disorders (Dysphagia); 14, Cultural and Linguistic Diversity; and 15, Gerontology. phillip.guillory@gmail.com×
Article Information
Hearing Disorders / Audiologic / Aural Rehabilitation / Augmentative & Alternative Communication / Swallowing, Dysphagia & Feeding Disorders / Special Populations / Cultural & Linguistic Diversity / Practice Management / Professional Issues & Training / Regulatory, Legislative & Advocacy / Telepractice & Computer-Based Approaches / Speech, Voice & Prosody / Features
Features   |   November 01, 2017
Beyond Word-for-Word Interpreting
The ASHA Leader, November 2017, Vol. 22, 46-52. doi:10.1044/leader.FTR1.22112017.46
The ASHA Leader, November 2017, Vol. 22, 46-52. doi:10.1044/leader.FTR1.22112017.46
“Just say what I’m saying, word for word!” It’s common for interpreters to hear this from clinicians. But this statement can have different meanings.
The most obvious meaning would be to simply repeat, in the same language, every word spoken in precisely the same order. As applied in Spanish, for example, “I am Phil,” might be said, “Yo estoy Felipe.” But that’s likely not what is being requested.
It’s more likely that the clinician aims to have the message content conveyed effectively in the target language. For example, in Spanish, “I am Phil” might be the more conversationally appropriate “Soy Felipe.”
When it comes to audiology and speech-language pathology, these types of distinctions are particularly important because communication is our business. In our work, it’s critical to bridge language barriers with our students, clients and patients with limited English proficiency.
But if we work with interpreters to help overcome those barriers, we need to be clear on what we want from them. Per the word-for-word example, we need to know what, exactly, to ask for. And we need to know what type of interpreting service(s) we need, how to find someone qualified, and how to work effectively as a team. It’s also helpful to understand the legal basis for interpreting services.

If we work with interpreters to help overcome language barriers, we need to be clear on what we want from them.

How does this work?
In busy clinical life, it’s easy to get wrapped up in demanding caseloads. All too often we assume that interpreters are there merely to ensure that students, clients and patients understand us. As an interpreter, I like to remind clinicians that I—the interpreter—am also there to make sure that they, in turn, understand students, clients and patients.
I am conveying the respective messages between the two parties, but I am also, where appropriate, conveying linguistic nuances (to each side), as well as supporting understanding of cultural differences.
Some clinicians I’ve worked with have expressed uncertainty about working with an interpreter. Some tell me interpreters have connected better with their clients than they have. These issues do arise. But working well with interpreters is possible: Knowing how to speak an interpreter’s language can go a long way to building trust, rapport and a solid relationship that bolsters patient care.
Let’s start with the basics. We’ll define the three most common interpreter-related terms—each function can be done by different people or the same person.
I interpret from English to American Sign Language (ASL) for some people, transliterate English into signed English for others, and can translate written English texts into, for example, a filmed ASL text (as ASL does not have a written form). But, often, different people provide interpreting services and translation of texts.
Here are the three most common functions and examples of their use.
Interpret: To convey a message (spoken or signed) from one language to another.
This service is likely the most common type of language service you’ll request. An interpreter can help facilitate communication between the clinician and client during an evaluation or treatment session. If you anticipate working with a client for several weeks or months, you may want to request the same interpreter (or team of interpreters) to ensure consistent use of vocabulary, a solid foundation and a shared history.
Translate: To convey written text from one language to another.
This service is likely the second-most common request, and is most frequently confused with interpreting. Translation relates to frozen text: a book, article, song, play, movie and so forth. Clinicians may need to have English-based materials for clients translated into a different preferred language. An interpreter may perform “sight translation”: reading a document and then producing it verbally or manually in real time. This function might be needed for administrative documents such as consent for treatment, Health Insurance Portability and Accountability Act (HIPAA) forms and more.
Transliterate: To convey a message from one form to another form of the same language.
Transliteration is likely most familiar to ASL/English interpreters. In that context, it refers to using ASL signs and features—such as use of space and other visual markers—to produce a message using English grammar and syntax. It also applies to cued speech and oral transliteration, though these are less common.
Cued speech is a type of signed system that uses handshapes to complement mouth movements to distinguish phonemes from one another. Oral transliteration refers to mouthing (without voicing) what is being said. One particular challenge for oral transliteration is that in English, for example, only about 30 percent of sounds are actually visually recognizable, and there is no way to distinguish voiced from voiceless phonemes (such as /p/ and /b/, /f/ and /v/).
Spoken language services may have different people handle each service. For example, an agency may have dedicated staff to provide interpreting services and a separate staff to translate written documents. For ASL/English interpreters, it is common for interpreters to provide more than one of these services.
Advocating for interpreter services
Once clinicians recognize the need for an interpreter’s services, many run into difficulty having management approve them because of associated costs. But there are also strong legal reasons to hire interpreters that can bolster your case.
Knowing the laws on provision of language access can help you advocate for yourself and your clients. Relevant here, of course, are:
  • The Individuals With Disabilities Education Act (IDEA).

  • Executive Order 13166 for Limited English Proficient (LEP) Individuals (2000), established under President Clinton and retained under President George W. Bush and President Barack Obama.

  • Other important regulations, effective July 18, 2016, and developed per the Affordable Care Act, require providers who receive Medicaid or Medicare funding to provide free translating services (including sign language) to people with limited English proficiency and to post publicly that these services are available (see “Are Your Services Accessible to All?”).

  • The Civil Rights Act of 1964, which includes the Title VI proclamation that “No person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.”

Other federal legislation also includes provisions relevant to translators.
Rehabilitation Act (1973), best known for section 504:
  • Establishes precedent of illegality for federal agencies or programs or activities receiving federal financial assistance to discriminate against qualified individuals with disabilities.

  • Includes a “reasonable accommodation,” which relates to accessible buildings and accessible communication for individuals who are deaf and blind.

  • Includes provision of interpreters as a modification.

Americans With Disabilities Act (ADA, 1990):
  • Expands on the language provisions for people with limited English proficiency provided by the Civil Rights Act (1964) by including individuals who are deaf and hard of hearing.

  • Title III: Public Accommodations and Commercial Facilities includes 36.303: auxiliary aids and services (read: interpreters), which holds: “ … no individual with a disability is excluded, denied services, segregated or otherwise treated differently than other individuals because of the absence of auxiliary aids and services … ” It also includes provision of qualified interpreters on-site or through video remote interpreting (VRI).

One place to start searching for an interpreter is your local interpreting agencies. A simple Internet search may yield a variety of companies, but a local one is preferable: They are most familiar with the community.

How to find an interpreter
Some clinicians are fortunate to work in settings that have their own interpreting services departments. Others with fewer resources may turn to use of ad hoc interpreters, who can include family members, friends or bilingual staff. While these clinicians may lack alternatives, using ad hoc interpreters can pose ethical issues: Family members and friends likely hold biases regarding a client’s care, and asking bilingual staff to interpret is both outside their scope of practice and may introduce unanticipated consequences.
For these reasons, it’s best to use professional interpreters. One place to start searching for one is your local interpreting agencies. A simple internet search may yield a variety of companies, but a local one is preferable: They are most familiar with the community.
If you live in a small town, you may need to search the nearest city. There may be more resources available, including interpreters who may live in or can travel to your area. It’s important to look at which services are provided, such as interpreting and translation services, and what sort of certification(s), if any, their interpreters and translators have.
Another option is using phone interpreters—long available at many health care facilities. Video remote interpreting is also increasingly prevalent. Think critically about the needs of your setting. Phone and video remote interpreters can be located anywhere in the country, so they may be unfamiliar with your community. Also, with these systems, you will likely have a different interpreter each time.
Knowing the pros and cons of working with in-person, phone and video remote interpreting can empower clinicians to decide which type can best meet their needs to provide excellent patient-centered care.

Remember that the interpreter is there to help you understand your client, just as much as they’re there to help your client understand you.

Appointment time
Now that you’ve learned about the types of language services available, and how to find appropriate services and advocate for your clients, how can you take what you’ve learned and make for a quality interpreter-facilitated experience for all?
  • Focus on patient-centered care: Be sure that you’re talking directly to your client and maintaining eye contact. Avoid looking at the interpreter and asking, “Ask him/her why they’re here today.” When the client is responding, maintain eye contact with them, just as you would with someone whose language you also speak.

  • Meet with your interpreter(s) ahead of time if possible: Ask your interpreter(s) to arrive early so that you can review your plan of care for the client. Explain concepts that may come up, what to watch for, and what you need from them. For example, if you’re working with a client who just had a stroke, you might explain that you need the interpreter to clearly convey what the client says, no matter how nonsensical it may sound. I also tell interpreters to let me know if the client doesn’t appear to understand what they’re hearing. That way, we can work as a team to improve comprehension.

  • Consider how culture can influence communication and swallowing disorders: Be open to asking your clients about their culture, and how it might relate to their condition. Interpreters can also be excellent cultural mediators. You may, when meeting ahead of time, ask your interpreter to help explain certain cultural elements to help you make more patient-centered, well-informed clinical decisions.

  • Remember that the interpreter is there to help you understand your client, just as much as they’re there to help your client understand you.

Interpreters can help take the guesswork out of working with clients with limited English proficiency, while simultaneously helping you provide the best care you can. Providing equal access to communication is essential for informed clinical decision-making. Our clients and patients deserve nothing less.
1 Comment
November 9, 2017
Amy Waite
Professional Interpretation
I agree with most points in the article but I submit that if your interpreter is a professional (which they should be!) they would know to change the word order or other nuances if it is better represented in the target language (e.g. Soy Filipe). That is something they are taught in a basic Intro to Interpreting class. A professional will also ask your permission when they need to change or explain something beyond the normal amount. I think the most important part is to only hire professional, certified interpreters. I routinely advocate with my administration and workers comp case managers until an expert interpreter is provided. Until we insist on this the untrained bilingual "interpreter" can flourish. This is dependent on state, of course. No one tells me how to do my job each day and I shouldn't have to tell an interpreter how to do theirs. Otherwise they are not an actual interpreter. That is my feeling.
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November 2017
Volume 22, Issue 11