Transcript Working With Video Remote Interpreters

In Person and Video
Remote Interpreting
Know your Facts
Presented by
Rachel Spillane
M.Ed., CSC, OTC
Director of Deaf Out Reach
Services
Interpretation Methods
 Can be done by Face to Face (in person)
 Can be done thru video remote
 Can be done by phone
 Can be written translation
Video Remote Equipment
 Equipment and installation requirements
Steps of the VRI System
Step One: The
hospital personnel
phones the VRI
agency to request
the VRI service
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 Two: The agency
then contacts the VRI
interpreter with the
request
Step Four: The
Interpreter then
initiates the VRI
connection
The Difference between
VRS & VRI
VRS
VRI
 Phone Relay Service
 Video to Video Service
 Controlled by FCC
 No Controls, just
 Can only be located in
 Can be located in
approved Centers
partnership agreement
Interpreter’s home and
follows HIPAA/RID
confidentiality
guidelines
The Difference between
VRS & VRI (continued)
VRS
VRI
 Variety of Topics
 Specialized Topics
 Qualified Interpreters,
 Interpreters should be
does not mean certified
or trained to cover all
topic matters
RID Certified and had
specialized training i.e.
Medical
Demand vs Supply
 The Sign Language interpreter pool is facing a
shortage, in some areas of the country it is
severe.
 The shortage is due to the following reasons:
Advent of VRS (Video Relay Services) ,
dwindling numbers from training programs, the
largest pool of interpreters are nearing
retirement , demand from business and
educational settings have increased etc.
Embarking on Video Remote
Business
 Consider equipment needs: connectivity
 How to man the system
 Where to place the end point systems i.e. in
centers vs interpreters homes
 Cost of running this type of system
 Training Hospital Staff, deaf patients and
interpreters
 Consider Federal, State regulations, guidelines
Cost of running VRI
 Over head costs: of hook up, T1 lines, phone lines, gate
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keeper, border control , paying 3 shift employees
salaries
Billing costs
Equipment costs: average cost of small VRI unit is
anywhere from $2500 and up
Average yearly cost of running this type of business with
bare bones staffing is about $200,000 per year.
With 7 hospitals on, this is volume based business you
would see of an average of $1500 a month
Most major VRI companies will tell you that they were in
the red for more than 5 years before they saw a profit.
Again this is volume based business
Importance of Developing Training
Materials
 Hospitals need to know how to appropriately use
interpreting services
 Must develop training materials that is
accessible and easy to implement i.e Power
Point Presentation on hospital computer system
for on going training, pamphlet (1 page) that is in
accessible location for staff
 Must physically go to the hospitals on a periodic
basis to present the power point training due to
staff turnover and if staff hasn’t had the
experience of requiring interpreting services
(Reinforcement is Key)
VRI Guidelines
Possible
Inappropriate
VRI Situations
Technical
Difficulties
Visual Barriers
Cognitive
Barriers
•Technical Difficulties
 VRI clarity is based on type of connection, if it is based
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on equipment use overall in a hospital, a power drain will
produce a poor quality picture. Sometimes the picture
will freeze up. The Interpreter will have to disconnect
and reconnect. This may happen several times during a
session.
If the settings on the VRI have been changed
inadvertently you will receive no picture.
Troubleshooting has to occur here to get the appropriate
setting
If VRI is wireless, there could be dead zones in the
hospital where the VRI will not work at all. similar to cell
phone problems.
Power outage or equipment failure can occur
If troubleshooting takes more than 10 minutes, the
hospital should call for an on site interpreter
Visual Barriers
 If there is too much equipment in a room or the
equipment will interfere with the use of the VRI.
The VRI should not be used. An example of this
would be eye exam. The exam takes place in a
dark room with a lot of equipment. The
equipment is a barrier for the deaf consumer to
even see the VRI interpreter. Another example
would be hearing test. The room is lead
shielded and prevents wireless connection to the
VRI unit.
Visual Barriers
 Deaf consumer has vision loss that will
prevent the person from using the VRI.
Cognitive Barriers
 If the Deaf consumer has cognitive
impairment due to alcohol/drug, or is on
medication that impairs judgment, has TBI,
Senility, Alzheimer, and mental illness.
VRI should not be used under these
circumstances.
Decision to use VRI or not to use
VRI
 The hospital personnel should always
explain fully to the deaf patient when
making a medical appointment about the
interpreting service options. The final
decision of how the communication is to
be handled should always be left to the
deaf person. VRI should never be forced
on a deaf patient.
The next few slides are
examples of what to include in a
training power point to the
hospital staff
Situations where the VRI is
appropriate
 Emergency Room-admissions information for triage to
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formulate treatment plan
Pre-OP, to explain procedure and to fill out hospital
questionnaire, consent form etc
Prior to a routine procedure i.e. x-ray, MRI,CATSCAN,
Physical Therapy etc
Short routine office visit (less than ½ hr)
Doctor’s rounds
When medical staff needs to talk to a patient who is
hospitalized for an update on patient’s status
Discharge planning
Situations where VRI
should not be used
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Post operation
Equipment barriers (lead shielded rooms etc)
Patient is not coherent
Patient’s ability to use the VRI or patient’s
personal preference to have on site interpreter
 Emotionally Sensitive information
 Complicated and Risky Procedures
 Certain Mental Health situations i.e. patient is in
restraints etc.
Mental Health
 If the patient is comfortable with using the VRI
for mental health status, one on one counseling
etc
 In groups, you have to consider the all the
participants. This is probably not a good venue
for the VRI. The other issue is the ability to hear
who is speaking and this could pose a problem
 If patient is in restraints or out of control, having
auditory and/or visual hallucinations then the
VRI is not appropriate
What the medical staff needs to know in
order to facilitate communication through
the VRI
~Always direct your comments to the deaf
patient DIRECTLY. Stand next to the VRI
so patient can see you and the interpreter
~Be aware that everything that is
heard or seen by the interpreter will be interpreted
~Give the Interpreter time to explain what is going
to occur before you proceed with an action (i.e.
insert the needle into the patient’s arm)
What you need to know
 Remember not to block the patient’s view
of the interpreter and vice versa
 If you leave the room and plan on not
returning for a while, inform the VRI
interpreter so they can disconnect and
make arrangements for a reconnection at
the appropriate time
Privacy Guidelines
If the patient is not in a private room the
following steps will need to be taken:
1.
Make sure the volume on the VRI unit is turned
down so other people not associated with the
patient cannot hear what is being said
2.
Make sure the VRI unit is not visible to others not
associated with the patient
3.
Limit the amount of information that needs to be
stated at that point in time, until patient can be
moved to a more private location
Advantages of VRI
 Interpreters on Demand
 Access to important information immediately for quick
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response
Better use of resources (a VRI interpreter can cover
more assignments in one day than an interpreter who
drives from assignment to assignment)
Pay for only the real interpreting time not the driving or
down time
Interpreter is not exposed to hazardous conditions
Can be a cost savings if used efficiently
Complies with the ADA legislation
The following slides are
examples of what you would use
to train your interpreting staff
The Interpreting Challenge
 Medical Terminology Interpretation
 Language Equivalents (expansions)
 Working in 2 dimensional environment has an impact on
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certain visual cues
Teaming
The interpreter has to make sure the lighting, contrast
and visibility is clear enough on both ends
The interpreter has to be aware and notify if picture
quality starts to disintegrate
The interpreter has to be aware and notify if audio levels
are compromised
VRI Teaming with CDI
 Certain patients have a compromised
communication issue and will need a deaf
interpreter along with the hearing
interpreter
 A CDI will be on site and will use the VRI
Interpreter to relay the message to the
patient
VRI Teaming with CDI
 The VRI Interpreter along with the CDI
interpreter will control the communication
traffic to make sure the CDI has plenty of
time to convey the message
 The patient will not be viewing the VRI
Screen, only the deaf interpreter will be
viewing the screen
VRI Teaming with CDI
 The patient will be in direct communication
line with the CDI
 Medical staff has to be aware not to block
visual communication either by standing or
putting equipment in front of the sightlines
of the interpreters and the deaf patient
VRI Teaming with CDI
 Technology is also available where both
the CDI and the hearing interpreter will be
on the VRI screen, in that case, the VRI
screen will be facing the deaf patient and
all other information listed above will still
hold
CDI Responsibilities
 CDI needs to be aware of environmental
information that needs to be passed onto the
VRI Interpreter
 CDI needs to be aware to pass on visual cues in
a subtle way as to not offend the deaf patient
 When the VRI is turned off, the CDI should leave
the room and establish a way for the medical
staff to alert the CDI when interpreting needs
arise
CDI
 CDI in a mental health setting need to be
aware of their signing affect so as not to
increase the patient’s anxiety or emotional
state
 CDI can determine if an onsite hearing
interpreter would be better suited for the
situation at hand
CDI
 CDI and VRI interpreters don’t have a way
at the end of the session to talk about the
teaming aspect of their work, so another
method has to be utilized
 CDI have to understand how
to work in a 2 dimensional
framework
Clear Communication
 Roles clearly defined
 Respect
 Effective Teaming (medical staff, VRI, CDI
and patient
 Eliminating barriers
 VRI should never be forced upon a deaf
patient even though it is stated that it
complies with ADA (lawsuits have been
filed in this arena)
The following slides give examples
of how you train and empower
your consumers i.e Deaf Patients
Take Charge of your
Communication Process
• When you make a medical appointment, ask
whether you will be getting an on-site interpreter
or VRI. This is the time to make your preference
known.
• If you are not satisfied with how the
communication is conducted (whether it is VRI
or on-site interpreting), ask to speak to the
Patient Relations Dept. or Nursing Supervisor.
• If unable to resolve the issue, you can file a
complaint with OPA (Office of Protection and
Advocacy)
Ask the VRI interpreter the following
questions:
A) What is interpreter’s name and what
company do they work for?
B) What is their certification level?
C) Has the interpreter had prior medical
interpreter training?
D) Is the picture and sound quality clear
How to Advocate for yourself
 Ask the VRI Interpreter the following
questions (continued)
 E) Do you understand the interpreter and
does the interpreter understand you?
 F) Is VRI appropriate for your situation?
Questions and Answer Period
 Thank you for attending and hopefully this
workshop gives you a plan to implement
clear communication on how to effectively
use interpreting services