Posted on 15 Comments

Critical Partnerships: Ethical Medical VRI & Sign Language Interpreters

Ethical Medical VRI & Sign Language Interpreters

Danielle Meder discusses the responsibility of sign language interpreters when working in medical VRI environments. Since VRI is here to stay, partnering with ethically responsible VRI providers is the most effective way to improve the medical VRI experience.

In her article, Behind the Screens: The Ethics of Medical VRI & Sign Language Interpreters, Shelly Hansen discussed her perceptions of the ethical implications of VRI. In addition, she explored the most common assumptions about VRI, at times upholding stereotypes while also utilizing extreme examples of patient experiences with VRI. However, by exploring how sign language interpreters and VRI providers can work together to raise the standards and improve the patient experience, VRI will be seen as one viable option for communication access.

[View post in ASL.]

If You Can’t Beat ‘Em, Join ‘Em

It is undeniable that VRI is here to stay. As a result, hospitals see the opportunity to provide immediate access, increase the availability of interpreting services when on-site interpreters are not available, in addition to seeing the cost-saving benefits of VRI–and as a result, they are making it a permanent part of their language access plans. However, many hospitals are misguided when it comes to the proper use of VRI for Deaf patients. It is unrealistic to imagine all ASL interpreters refusing to work for VRI providers in an effort to drive VRI out of medical environments. Therefore, it becomes the practitioner’s responsibility, when exploring VRI employment, to take positions with ethically responsible VRI companies; VRI companies where sign language interpreters have a voice and Deaf patients are respected.

Ethically Responsible VRI

It may seem like an oxymoron, but ethically responsible VRI companies do exist. Just as sign language interpreters vet any number of companies/organizations they work for, purchase from, or have relationships with, they can also do so with VRI companies. This vetting is not only from the perspective of potential employees but also as allies to the Deaf community. If local hospitals and clinics are going to use VRI, then it is imperative that VRI providers in local hospitals are working with Deaf patients.

As professional sign language interpreters, we should be asking VRI providers if they do the following:

  • Offer CDIs on-demand
  • Empower VRI interpreters to advocate for onsite when VRI is not effective or appropriate
  • Hire experienced and trained sign language interpreters in both medical and mental health vs. general practitioners
  • Provide training to hospital staff on how to utilize the VRI equipment
  • Offer cultural sensitivity training for providers when working with Deaf patients
  • Adhere to all national and state licensure laws for sign language interpreters
  • Provide readily accessible tech support to sign language interpreters and providers

If a VRI provider cannot answer ‘yes’ to the full list above, then practitioners are faced with two options: to not accept work from them or to accept work in an effort to help develop ethical business practices from within the company. Further, it’s important to include local Deaf communities in the conversations in order to limit the ill-prepared VRI provider’s presence in local medical facilities until they change their practices.

VRI Does Work/VRI is Not One Size Fits All

Unfortunately, there are a number of cases where VRI hasn’t worked, and the fallout has been devastating for patients and their families. There are also cases where unqualified onsite sign language interpreters have been hired, as well as medical encounters where no sign language interpreter (onsite or via VRI) has been procured. These situations create equally damaging results. Communication disasters are not exclusive to VRI, and while onsite is best, it’s not a guarantee of quality or effectiveness.

Most commonly, it is said that VRI ‘will do’ until an interpreter shows up on-site or only in a dire emergency room visit, yet there are plenty of times where VRI does work beyond the emergency room. It’s also important to note that VRI is used at the patient’s request, too. Patients are requesting VRI when they want privacy from their local interpreting communities; when they want an appointment this week instead of in two weeks when the first available onsite interpreter can be booked; when their local interpreters aren’t experienced enough; or when they want a CDI for their appointment and their local community doesn’t have or has a limited number of CDIs.

Frozen Screens and Dropped Calls Do Happen

One very real and unacceptable aspect of VRI is that frozen screens, heavy pixelation, and weak internet connections make communication cumbersome, at best, and often impossible. This can also lead to potentially dangerous health care results. It is the responsibility of the hospitals to provide a stable, secure, and strong internet connection. When sub-par internet connections are used, VRI providers, sign language interpreters, and Deaf patients must demand medical facilities invest in fortified internet services for VRI to even have a chance at providing effective, quality communication access. Without a robust Internet connection, even the best sign language interpreters will, in essence, have their hands tied. Again, if VRI is not going away, then it must be properly deployed on all fronts, and sign language interpreters can have a strong influence on that deployment.

ACA Section 1557

“Covered entities are prohibited from using low-quality video remote interpreting services or relying on unqualified staff, translators when providing language assistance services.”

“Providers’ required to give ‘primary consideration’ to the choice of an aid or service requested by the individual with a disability.”

These two statements are linchpins in the Affordable Care Act when it comes to language access. The first statement is the provision that holds providers responsible for quality and effective language access while the second statement is the provision that is most misunderstood and misused when defending the right to an onsite interpreter.

At one point last year, social media sites were ablaze with the phrase “primary consideration” and what that meant for patients. What many thought it meant was providers had to honor the patient’s preference for onsite sign language interpreters. What it means is that providers must consider a patient’s preference, however, if VRI offers effective communication access, then VRI can be used in lieu of an onsite interpreter (ACA Effective Communication). While a patient may want an onsite interpreter because they prefer it to VRI, preference is not a protected right; quality and effective communication is a right. Reasons onsite interpreters must be arranged, and VRI should not be used are when a patient is:

  • Low vision and/or blind
  • Experiencing a highly traumatic incident
  • Experiencing a psychotic episode
  • In a physical position or condition that prevents them from easily seeing and communicating with the interpreter
  • Case sensitive pediatric encounters
  • Not able to communicate because technology is not working reliably
  • Participating in group therapy

There are also case-by-case instances where VRI is not suitable.

I highlight this to further make a point; although VRI is not appropriate for all situations, it is not going away. Therefore, medically experienced video remote interpreters have a multi-layered responsibility. They must provide clear and effective interpreting, while also skillfully explaining to the provider, using healthcare terminology, why VRI is not appropriate for a given situation. Finally, the interpreter must advocate for onsite sign language interpreting services.

In Need of Standards

Currently, the only provisions in place for VRI are the terms ‘quality’ and ‘effective’ as put forth by the Affordable Care Act (ACA) and the Americans With Disabilities Act (ADA). No industry-wide screen size minimums exist, no mandatory medical interpreter certifications, nor experience requirements are in place. Additionally, no internet standards for medical facilities, nor protocol where VRI should not be used are set. At this time, the National Association of the Deaf (NAD) has written a position paper, and each VRI provider has their own business practices that may or may not align with NAD.

Much like courtrooms across America that have policies, rules, or laws in place which require sign language interpreters to be trained, vetted, and certified to work, medical facilities need to take the same approach when it comes to language access. The ACA made great strides when it stated that family, minors, and bilingual staff may not work as interpreters with patients. However, there is still work to be done to standardize what it means to be a medical interpreter whether onsite or in a VRI setting.

VRI and the CPC

All of the CPC tenets below can be honored and maintained while working in VRI with ethically responsible VRI companies. Sign language interpreters can assess the consumer needs and advocate for effective communication from the moment a VRI call begins through its completion.

2.0 Professionalism:

2.2: Assess consumer needs and the interpreting situation before and during the assignment and make adjustments as needed.

3.0 Conduct:

3.1 Consult with appropriate persons regarding the interpreting situation to determine issues such as placement and adaptations necessary to interpret effectively.

6.0 Business Practices:

6.3 Promote conditions that are conducive to effective communication, inform the parties involved if such conditions do not exist and seek appropriate remedies.

6.5 Reserve the option to decline or discontinue assignments if working conditions are not safe, healthy, or conducive to interpreting.

Further, advocacy should also extend to the leadership and management of the VRI company which, if their priorities are properly placed, will work with the medical facilities to educate them on the proper use of VRI.

Final Thoughts

The VRI industry is booming right now, and sign language interpreters are faced with the choice to accept employment opportunities within VRI or resist on principle. If we, as sign language interpreters and allies to the Deaf community, want to protect communication access in medical environments, then it is our duty to hold providers responsible for ethical practices. We know VRI is going to be one of the communication tools medical providers use, so we must work with ethically sound VRI providers to ensure quality and effective communication access is the top priority for all parties involved.

Guest Translator – Mistie Owens, BA, CDI, QMHI, YMHFAI, has been serving the local Deaf community as a CDI since 2011, although she remembers interpreting from her early youth. Dedicated to the healthcare field, she is employed by InDemand Interpreting and holds certifications as a Qualified Mental Health Interpreter and Youth Mental Health First Aid Instructor; her work in Mental Health and related disciplines are her passion. She resides near Salt Lake City, Utah with her husband and rescue dogs.

Questions to Consider:

  1. What committees or advocacy groups are in place that are working to create industry standards for language access and VRI?
  2. Who is holding VRI providers accountable when they negatively contribute to ineffective and unsuccessful medical encounters?
  3. How can ASL interpreters work within their own communities and with existing VRI providers to raise standards in language access in ways that honor Deaf patients while respecting legal and fiscal considerations?

References:

Hansen, Shelly. “Behind the Screens: The Ethics of Medical VRI & Sign Language Interpreters” StreetLeverage. N.p., 22 March 2017. Web. 24 April 2017.

Registry of Interpreters for the Deaf, Inc. “NAD_RID Code of Professional Conduct.pdf.” Www.rid.org. N.p., 2005. Web. 21 April. 2017.

Posted on 51 Comments

Behind the Screens: The Ethics of Medical VRI & Sign Language Interpreters

Behind the Screens: The Ethics of Medical VRI & Sign Language Interpreters

Shelly Hansen explores the ethical implications of VRI in medical settings, especially the impacts of dropped connections during sensitive consultations and loss of consumer choice regarding live, on-site sign language interpretation.

It’s all the rage. Those smooth little carts with satisfying clicks and keys. Sweet control, right here at my fingertips for your eyes. No more waiting for a live interpreter to arrive. No more scheduling…it is on demand 24/7/365. No more incorporating another breathing human being into the interaction; we’ve gone high-tech and modern, happy to share our space with a “machine interpreter”, the term used locally by health care provider staff for Video Remote Interpreting/VRI. The medical facility loves this kind of sterile control.

[View post in ASL]

The patient, on the other hand, may have a mixed response to the cyber–signer. Like cafeteria food and military MRE’s, this is a one-size-fits-all solution. If a person has vision issues, is not a strong signer and/or struggles with the style, speed or information from the “machine interpreter”, if they are dizzy, lying down awkwardly, giving birth, going into a radiology department, are from a foreign country and need a specialized sign language, are elderly and prefer a familiar interpreter, are an active child with attention issues or a CODA utilizing the interpreter, would benefit from techniques used by CDIs such as physical movement, drawings or references to visual aids in the immediate environment (including the current meds list on the computer charting screen), or struggle with paperwork and literacy challenges, they are out of luck. Not only are these individuals out of luck, they now need to self-advocate against a large medical institution or physician who has already invested in a “solution” to this communication barrier, and who feels that due diligence has been satisfied.

Communication in Context

When I step back and consider these experiences as a whole, the impact of VRI appears to be greatest on vulnerable adults. We can all find ourselves vulnerable at times, and some individuals may consistently interact as vulnerable adults. I have noticed that communication is most effective in the context of relationship when interpreting for these encounters. The negotiated meaning within a tangible human relationship provides a context for effective communication that mitigates barriers for vulnerable adults and provides a level of comfort needed to genuinely engage with others. While it may seem an overstatement, trust in the interpreter allows for depth of conversation that is not possible for some clients via technology which has an “outside, looking-glass” quality. I consistently hear feedback about “not remembering what they said”, “not understanding but agreeing anyway” and being told there “weren’t any live interpreters available” when those facilities aren’t calling live interpreters any longer as a standard procedure.

“Do No Harm”

RID Certified sign language interpreters historically have been vigilant to “do no harm”, maintaining high professional standards of ethical conduct, creating ethical codes of conduct, establishing ethical review boards and making every effort to provide quality service to the Deaf, Hard of Hearing, DeafBlind, Late-Deafened, and Hearing communities as allies and professionals. This commitment to the profession has enabled increased access to places of public accommodation throughout society and is a source of quiet pride and job satisfaction for many sign language interpreters who are committed to increased equality, autonomy, and self-actualization.

As a freelance community sign language interpreter, I have seen a dramatic shift in medical interpreting assignments from live interpreting to VRI supported interactions. As I sit on the cyber-fence, wanting to continue the work I love and provide services to people who need, want, and are requesting live interpreters, I am faced with an ethical dilemma. Do I participate in a flawed and “do some harm” medical VRI system because my livelihood is being affected by marketplace shifts?

Sample Scenario of a Botched VRI Appointment

A patient goes to a medical appointment in a facility to discuss the results from a recent scan with a specialist. The office uses a VRI system. The patient is optimistic about VRI, despite prior frustrations with freezing screens and dropped connections resulting in re-scheduled appointments with a local, familiar, RID certified “live” sign language interpreter. The doctor begins to review the results of the scan along with the possible issues that may be causing symptoms of concern. The “worst case scenario” is discussed and then the VRI starts to cut out, freezing. The tech issues cannot be resolved, again. The doctor, exasperated says, “This is not a service, it’s a DIS-service.” The appointment is abruptly curtailed and a follow-up appointment is scheduled for next week with an onsite, “live” interpreter.

When the appointment begins the following week, the “live” interpreter is unaware of the previous snafu. The doctor begins again to explain the medical condition, and informs the patient that s/he does NOT have the fatal condition. The patient breaks down. For an entire week, the last message about the fatal flaw and partially explained scan image had left the person believing that they had the dreaded malformation and the condition was terminal. The visible relief on the face of the patient is combined with frustration and anger. Both the patient and doctor commit to no further VRI appointments, expressing relief to have an in-person sign language interpreter on site. They agree that using VRI just isn’t worth the frustration, miscommunication and emotional duress.

If the “live” sign language interpreter left the room at the moment of diagnosis, s/he could lose her/his certification for ethical malpractice. The patient could file an ethical complaint with RID stating that the interpreter violated NAD-RID Code of Professional Conduct tenets 6.2 and 6.4 (see below).

Unintended Consequences

In my area, an older gentleman took his own life after receiving a terminal diagnosis. His family found him alone in the backyard. To my knowledge, this was not an interpreted interaction. However, it is possible that someone could react with serious consequences to a misunderstood partial-diagnosis. A scenario like this happened January 2017 at the Limerick Hospital in Ireland. A man received a terminal cancer diagnosis and took his own life in the hospital chapel.

Codes of Professional Conduct

Let’s look at some pertinent codes of conduct for medical sign language interpreters.

IMIA (International Medical Interpreters Association)

“Responsibility Toward Ensuring Adequate Working Conditions” The interpreter shall strive to ensure effective and productive communication in any professional situation and make every effort to have working conditions in place that will allow him or her to provide quality interpretation services.

“Right to equal treatment” Patients have a right to receive treatment in a language they understand; these rights are governed by federal anti-discrimination laws and the ADA.

“Informed consent” Patients should be aware of treatment options and consent to treatment only after understanding these options. Communicating information accurately is essential to informed consent.

“Beneficence” The health and wellbeing of patients is a core value in all health care professions, as well as in medical interpreting.

The NAD/RID Code of Professional Conduct

4.0 Respect for Consumers

4.1 Consider consumer requests or needs regarding language preferences, and render the message accordingly (interpreted or transliterated).

4.4 Facilitate communication access and equality, and support the full interaction and independence of consumers.

6.0 Business Practices

6.2 Honor professional commitments and terminate assignments only when fair and justifiable grounds exist.

6.4 Inform appropriate parties in a timely manner when delayed or unable to fulfill assignments.

6.5 Reserve the option to decline or discontinue assignments if working conditions are not safe, healthy or conducive to interpreting.

Similarly, the National Code of Ethics for Interpreters in Health Care includes “beneficence” and “do no harm,” along with “fidelity”:

“The essence of the interpreter role is encapsulated in the value of fidelity. The American Heritage Dictionary of the English Language describes fidelity as involving the unfailing fulfillment of one’s duties and obligations and the keeping of one’s word or vows.”

More Questions than Answers

How can a career medical interpreter agree to work as a VRI medical interpreter with the knowledge that predictable and unresolved VRI technical issues, including consistently disrupted and poor quality connections and communications, are occurring throughout the healthcare system and political practice issues in which “one size fits all” approaches that dictate language use without options for live on-site sign language interpreters are creating barriers for consumers that violate medical and RID certified interpreter ethical standards? Does the interpreter ignore these issues and shift that duty to the health care system and VRI employer, and ignore the systemic impact of complicit participation in a flawed approach to health care interpreting?

At the moment, I am working triage. Those failed VRI encounters, re-scheduled appointments, miscommunicated partial diagnoses are creating a clean-up tier of work for live interpreters. I’m holding out for “live” interpreting, despite the economic uncertainty of increased VRI use and the lower hourly wages those positions offer. Do I want to be part of the machine interpreter phenomenon? How can I ethically participate in quality healthcare interpretation in 2017 and beyond?

Questions to Consider:

  1. What protections are in place for consumers of medical VRI? Are there rating or feedback mechanisms available to track customer and provider satisfaction post-appointment?
  2. What alternatives are available or recourse do consumers have in the event a VRI appointment fails and are there systems in place to allow patients to pre-select live or VRI preferences especially for sensitive or technical appointments?
  3. What duty does an RID certified interpreter have in medical VRI settings and is that duty usurped by VRI companies and medical facilities choosing to eliminate live on-site interpreting in favor of machine interpreting?

References:

The National Council On Interpreting In Health Care, and Working Papers Series. A NATIONAL CODE OF ETHICS FOR INTERPRETERS IN HEALTH CARE (July 2004.): 8. Web. 21 Mar. 2017.

Registry of Interpreters for the Deaf, Inc. “NAD_RID Code of Professional Conduct.pdf.” Www.rid.org. N.p., 2005. Web. 21 Mar. 2017.

“International Medical Interpreters Association Code of Ethics.” IMIA – International Medical Interpreters Association. International Medical Interpreters Association, n.d. Web. 21 Mar. 2017.

Collins, Pamela. “Bringing Scheduling Into View: A Look at the Business of Sign Language Interpreting.” Street Leverage. N.p., 17 Aug. 2016. Web. 21 Mar. 2017.

Posted on 30 Comments

UpCycling the CPC: Role Space and the Reasonable Interpreter Standard

UpCycling the CPC

In search of the “Reasonable Interpreter Standard”… Re-thinking the NAD-RID Code of Professional Conduct with a fresh look at current best practices, recognition of role-space, advocacy and social media ethics.

Hurray! The RID Code of Professional Conduct Review Committee report came out on 6/23/2015! Many of us are eagerly awaiting a revised CPC. After reading through it, I felt inspired to sit down and draft a document which constitutes my approach to the intricacies of ethical practice, both philosophically and pragmatically, in my daily community sign language interpreting work.

[Click to view post in ASL]

This proposed draft is the fruit of fantastic input from a variety of sources (listed below) and also from the sometimes painful juxtaposition of the perceived proper role of a professional interpreter and an outdated CPC. As an interpreter who works for a variety of agencies and entities over a large geographic area, this proposed CPC is more compatible with my collective experiences over the past 26 years as an ASL interpreting practitioner and attempts to address many of the concerns raised in the recent CPC Review Committee report.

Your input and perspectives are invaluable! Share your thoughts on this important topic that has far reaching implications for individual interpreters and the community at large.

Thank you!

Code of Professional Conduct for ASL Interpreters (DRAFT)

Preamble

Interpreting is an art and service profession. Interpreters work to provide access for individuals who do not share a common language or language mode. To demonstrate their commitment to the technical as well as relational components of the work to remove language barriers, respect cultural norms and promote shared communication, RID Certified American Sign Language Interpreters shall adhere to the following professional standards that both guide interpreter conduct and protect the public trust in certified interpreters.

Applicability

All RID Certified Interpreters are bound to comply with this Code of Ethics. Interpreting students and interns are encouraged to adhere to this Code as pre-professionals, in conjunction with supervision by RID Certified interpreters, mentors and instructors.

Tenets

1.  Accurate and Complete Interpretation

Each participant’s source language should be faithfully rendered in a manner that conserves and conveys all meaningful elements of the speaker’s message and intent into the target language. A natural prosody that reflects the tone, style and register of the speaker should be employed. The interpreter shall strive for the highest standards of accuracy to enable the parties to clearly communicate with one another and avoid misunderstandings. The interpreter shall make repairs promptly and discreetly. If at any point an interpreter is unable to fulfill this tenet, the interpreter has a duty to either decline or remove her/himself from the assignment. Sight translation of forms and documents is within the scope of practice. Consecutive, simultaneous, team or relay interpreting with an intermediary interpreter are all valid approaches to this task, and the interpreter shall use professional discernment to request a team interpreter to effectuate communication.

2.  Commitment to Autonomy

The interpreter shall constantly strive to support full autonomy of the participants. While some situations may require the interpreter to make adjustments such as improved positioning, lighting or other logistical considerations, the primary focus will be to facilitate  participant autonomy. The interpreter shall avoid interjecting actively into the conversation or message. Exceptions include utterances which constitute social pleasantries, responding to direct questions, management of the interpreted interaction such as checking in with the parties to ensure the interpretation is clearly conveyed and accessible, clarification of content and professional courtesies.   Interpretation is a group activity creating a shared experience, and the interpreter has a duty to interact in ways that are socially responsive, culturally and linguistically inclusive and also maintain an overarching commitment to participant autonomy.

3.  Confidentiality

Privileged or confidential information acquired in the course of interpreting or preparing for an assignment shall not be disclosed by the interpreter without authorization. Data and records shall be handled using current industry standards including password protected computer files, locked cabinets and shredding of obsolete documents. HIPAA laws or any other federal, state or local laws governing information management shall be adhered to strictly. Interpreters work in a variety of settings for a variety of entities. Case studies, which are representative of repeated occurrences within interpreted interactions over time, can be shared with peers for the purpose of analysis and professional development in the same manner that other professionals conduct continuing education with the goal of improved service outcomes. Interpreters may make public comment on public information.

4.  Professional Demeanor

Interpreters shall conduct themselves in a professional manner that engenders respect for all parties. This applies to standards of dress which are conducive to a visually accessible interpretation. For most interactions business casual is appropriate. Identification such as a badge is recommended to assist the parties in readily identifying the working interpreter.  Examples of professional conduct include prompt confirmation of availability, fulfillment of confirmed assignments and punctuality. The interpreter shall maintain appropriate professional boundaries and separate personal from work interactions out of respect for all parties. Social media shall be used judiciously with consideration for all parties with particular attention to maintenance of standards of confidentiality. Obtain permission from all parties before posting shared experiences on social media or online.

5. Collegiality

Interpreters shall strive to work effectively, professionally and in good faith with all colleagues, mentoring partners, interpreting interns and students. Team interpreters shall caucus as needed before, during and post-assignment to ensure an optimal interpretation. Colleagues shall be approached directly, privately, one-on-one, to address any concerns or breaches of ethical conduct. Filing of grievances shall be made only after all other standard conflict resolution methods have been unsuccessful. Every effort shall be made to maintain open, accountable and positive relationships with peers that support full communication access for all parties.

6.  Preparation

Interpreters shall make all necessary efforts to prepare adequately for assignments. This includes obtaining preparation materials such as speeches, meeting agendas, documents, textbooks, police reports, etc., that will promote the most complete and accurate interpretation.

7.  Conflicts of Interest and Role-Space

Interpreters shall avoid conflicts of interest and dual roles which result in diminished capacity to devote full attention to the task of interpreting. The concept of a conflict of interest is well established, and interpreters shall adhere to norms of conflict of interest avoidance, both perceived and actual. Unanticipated conflicts of interest shall be disclosed to the parties promptly. Complete neutrality, or the absence of vested interest is not achievable.  Interpreters are dedicated to effective communication for all parties. However, interpreters can commit to fully participate in the role-space of interpreter to facilitate communication in order to support the parties in reaching their mutual goals of shared exchange.

8.  Professional Development

Interpreters shall maintain RID certification, completing required CEUs within each cycle, and also engage in supplemental continuing education, mentoring, pro-bono work, etc., to promote the furtherance of knowledge and skills within a framework of social justice. Membership and participation in professional organizations is strongly encouraged.

9.  Advocacy and Resource Referral

Interpreters are in a unique position as functional bi-cultural bilinguals. Interpreters shall provide referrals to available and appropriate community resources to support equal access. Interpreters may engage in advocacy services in settings that are separate from the interpreting function and that fall within standards of acceptable professional conduct and do not constitute a conflict of interest.

10.  Functional Maintenance

Interpreting is physically, emotionally and mentally demanding. Interpreters shall make reasonable efforts to ensure that all members of the interpreting team have adequate supports, including breaks, to promote health and longevity in the interpreting field. Interpreters shall decline or discontinue assignments if working conditions are not safe, healthy or conducive to interpreting.

11.  Business Practices

Interpreters shall adhere to the highest standards of ethical business practices which include but are not limited to accurate invoicing, charging reasonable fees for services rendered which constitute a livable wage, payment of taxes, maintenance of licenses and professional liability insurance, etc. Interpreters shall engage in pro-bono interpreting. Interpreters shall refrain from using confidential interpreted information for personal, monetary or professional gain or for the benefit or gain of personal or professional affiliations or entities. Interpreters shall avoid interpreting in settings which involve payment terms that are inconsistent with the Americans with Disabilities Act or any other federal or state law or local statute prohibiting discrimination.

12.  RID ED: K-12

RID Certified ED: K-12 interpreters shall adhere to the most current version of the EIPA Guidelines of Professional Conduct for Educational Interpreters when working in K-12 educational settings.

13.  Court Certified Interpreters

Legal interpreters have an additional level of ethical accountability to the courts and judicial system. Interpreters qualified to work in legal settings by either federal or state regulations or by virtue of RID legal credentialing shall prioritize the applicable court interpreter oath and timely access to due process. Legal interpreters shall strive to comply with current best practices and make statements on the record, requests, disclosures and recommendations that represent current best practices for legal interpreters.

14.  Adherence to Federal, State and Local Law

Interpreters shall abide by all federal, state and local laws which supersede this Code of Professional Conduct.   Interpreters shall fulfill all mandatory reporting duties and respond to subpoenas.

Reasonable Interpreter Standard

No illustrative behaviors are included. All tenets shall be considered using the reasonable professional interpreter standard. If an action, engaged in repeatedly, would promote:

  1. increased autonomy of the parties
  2. effective communication exchanges
  3. encourage public trust in the interpreter’s services

by actions taken in good faith effort adherence to these core tenets, the behavior should characterize that of a reasonable professional interpreter. For further assistance, please contact the RID Ethics Committee.

Questions for Consideration:

  1. Forget about dream vacations…What is your dream CPC?
  2. How do you want to see social media addressed collectively?
  3. Why is a succinct CPC preferable to a 5 page test-prep document?

 

References:

Llewellyn-Jones, P. & R.G. Lee (2014) Redefining the Role of the Community interpreter: The concept of role-space. Carlton-le-Moorland, UK: SLI Press.

National Association of Judiciary Interpreters and Translators.

Registry of Interpreters for the Deaf, Inc.

EIPA: Guidelines for Professional Conduct

Dean, R. K., & Pollard, R. Q (2011). Context-based ethical reasoning in interpreting: A demand control schema perspective. Interpreter and Translator Trainer, 5(1), 155-182.

 

Collegial Assistance:

Thank you to Xenia Woods, along with the Street Leverage staff, for their willingness to review and provide feedback and edits on this submission! Thank you also to Mr. Ed Alletto for his insightful legal trainings and gentle but direct prompting.

Footnotes:

Q:  Why aren’t there any definitions?
A: Unnecessary as this applies to the RID Certified Interpreters.

Q: Why not include the section about “representing qualifications accurately”?
A: Because it is already illegal to misrepresent yourself and this CPC only applies to RID Certified Interpreters

Q:  Why not address VRI/VRS?
A: Unnecessary as this applies to RID Certified interpreters regardless of venue.  Employment requirements are separate from a Code of Professional Conduct, which applies to members of a professional group.

Q:  Why not more illustrative behaviors?
A:  A CPC should be succinct.  This covers the core tenets and should be interpreted using the reasonable interpreter standard, which this version makes more explicit and should strengthen the application of this CPC.   It is not possible to list all applicable illustrative behaviors. It is possible to provide ethical principles with guidelines for making determinations that will result in ethical conduct.  See Model Code of Professional Responsibility for Interpreters in the Judiciary for an example of this format.

Q: Why not discuss the Demand Control Schema?
A: In my opinion, DCS is a is a tool used to manage the interpreting interactions, but is not appropriate in a CPC. Individuals can engage in behaviors that do not match up with the CPC, and then state a need to use certain controls because of demands that are the result of earlier poor choices that could have been avoided. The CPC should stand above the DCS, which then can be used to comply with the CPC. [Edit 8/6/15.]

Q: Why not include a separate tenet for medical interpreters?
A: This may be necessary at a future date if a separate medical certification is added by RID.  At the moment this CPC along with HIPAA laws and contracting terms provide sufficient ethical guidance. (For example: no unsupervised access to clients, and stepping out of exam rooms when patients need additional privacy.)

Q: Why not make this binding for students/interns?
A:  The CPC can only be binding for certified members, who can participate in grievance procedures, be sanctioned and have their professional certifications suspended or revoked. Students may, for example, have a course requirement to adhere to the CPC in order to participate in an internship placement, but do not have a professional duty to adhere to the CPC until achieving certified status.  The number of non-RID certified interpreters working in the field continues to decline, as states adopt requirements for licensure that are predicated upon RID certification. The onus is on the RID Certified interpreter to guide the student/intern to adhere to the CPC.  See the ABA Model Rules for Professional Conduct Rule 5.3 for an example of this supervisory relationship.

 

Posted on 22 Comments

Sign Language Interpreter for Hire: Ethics of Direct-Pay ADA Violations

Sign Language Interpreter for Hire: Ethics of Direct-Pay ADA Violations

Proposal to standardize RID Certified ASL interpreter response to surcharges to Deaf/Hard of Hearing or Deafblind clients for auxiliary aids by places of public accommodation in compliance with ADA law.

[Click to view post in ASL]

What motivates interpreters to continue in this field for decades? Lately, I have been reflecting on how integral and motivating social justice is to an ongoing passion for interpreting. Long days, solo days…days when you really do a good job and days when there is much room for improvement.

With both hands on the ruby frame of social justice, I would like to posit a question to our sign language interpreting community, in the hopes of challenging tacit understanding and stimulating dialogue that leads to change at the national RID-NAD CPC level.

(Note: The scenario below is offered as a case study, and is not representative of any particular encounter.)

The Scenario

You arrive to interpret for a client in a court-ordered setting. The per-session rates for the one-on-one and group meetings are posted on the treatment center lobby wall.  The client informs you upon arrival that the cost was excessive, more than double the rate paid by the general public, and had to be made in cash. You respond by offering to interpret for the client and office staff to sort out the perplexing payment issue. The office staff confirms that payments include a substantial surcharge for the interpreting costs including the agency referral fee and cannot be adjusted.  In sinking “Oh no…” shock, you interpret the remainder of the appointment and are left to drive home and ponder what actions can be taken as a RID certified sign language interpreter with a duty to conduct your practice in an ethical manner. A vision of Anna Witter-Merithew gently invoking the mantra “Do No Harm” comes to mind. Your considerations are within the framework of an ADA violation that is unwelcomed by the D/HH/DB client who vehemently does not want to be paying more than the general public for a public accommodation service.

How is an RID certified interpreter to respond?

(Note: the scenario below is offered as a case study, and is not representative of any particular encounter.)

Interpreter A – Response

My job is to interpret. The payment situation is not my issue to address. While I may not agree with it, it is between the D/HH/DB person and the treatment center to work out the financial details. I can encourage the person to contact the local advocacy agency, provide information on the ADA and resources such as the NAD website, and provide contact information for the state Administrative Office of the Courts. To withdraw from the situation would be presumptuous and a demonstration of audism because I would be taking away the D/HH/DB person’s right to pay for services, which would be condescending, a form of advocacy, an interjection of my personal opinion, and inappropriate. I cite the CPC…tenets 2.5, 2.6 and 3.3 as the basis of my ethical decision making process. I continue to interpret weekly meetings for many months, until the treatment is completed, receiving payment for my interpreting services via paychecks from an interpreter referral agency. I am confident other RID certified sign language interpreters would respond similarly.

2.5          Refrain from providing counsel, advice, or personal opinions.

2.6          Judiciously provide information or referral regarding available interpreting or community resources without infringing upon consumers’ rights.

3.3          Avoid performing dual or conflicting roles in interdisciplinary (e.g. educational or mental health teams) or other settings.

Interpreter B – Response

It is unethical for me to collect a paycheck that includes payment in violation of the federal ADA laws prohibiting discriminatory treatment of people with disabilities. I contact the interpreter referral agency and inform them I cannot continue to interpret because the D/HH/DB person is paying out of pocket for interpreting costs in violation of federal ADA law, and it is unethical for me to continue interpreting under the CPC as an RID certified sign language interpreter. I emphasize that when payments are confirmed to be ADA compliant, I will be happy to resume interpreting, but cannot in good conscience accept payment and so must reluctantly withdraw my services. I recognize this puts the D/HH/DB person in a difficult situation, but see my continued interpreting as complicit in discriminatory practices. I approach the board of the local interpreter referral agency and ask them to put a policy in place, if one does not already exist, that requires ADA compliant payment arrangements consistent with federal law, in order to protect sign language interpreters from being replaced and in support of the right to equal access for the Deaf community. I provide a slate of resources to the Deaf client, including state laws regulating court-ordered treatment.  I cite the CPC including tenets 2.6, 3.7, 4.4, 6.3, 6.5, 6.8, 7.2 and Applicability B. I am confident other RID certified sign language interpreters will respond similarly.

2.6          Judiciously provide information or referral regarding available interpreting or community resources without infringing upon consumer’s rights.

3.7          Disclose to parties involved any actual or perceived conflicts of interest.

4.4          Facilitate communication access and equality, and support the full interaction and independence of consumers.

6.3          Promote conditions that are conducive to effective communication, inform the parties involved if such conditions do not exist, and seek appropriate remedies.

6.5          Reserve the option to decline or discontinue assignments if working conditions are not safe, healthy or conducive to interpreting.

6.8          Charge fair and reasonable fees for the performance of interpreting services and arrange for payment in a professional and judicious manner.

7.2          Keep abreast of laws, policies, rules, and regulations that affect the profession.

Applicability B: Federal, state or other statutes or regulations may supersede this Code of Professional Conduct. When there is a conflict between this code and local, state, or federal laws and regulations, the interpreter obeys the rule of law.

ADA law: CFR 28 Section 36.301(c) Charges. A public accommodation may not impose a surcharge on a particular individual with a disability or any group of individuals with disabilities to cover the costs of measures, such as provision of auxiliary aids, barrier removal, alternatives to barrier removal, and reasonable modifications in policies, practices, or procedures, that are required to provide that individual or group with the nondiscriminatory treatment required by the Act or this part.

Sign Language Interpreter for Hire: Accepting Self-pay Terms

While this is a sample case study, it is not an isolated scenario. Most sign language interpreters, at some point in their career, will be approached by a D/HH/DB client wanting to direct-pay, and will need to make a determination to accept or decline those payment terms. For example, an interpreter may accept direct payment for a private family event such as a bridal shower or family reunion, but decline payment for a funeral, offering to interpret pro-bono. Neither of those situations are “places of public accommodation” under the ADA. However, there are situations that are blatant ADA violations. For example, an interpreter may decline to interpret for a driver’s education course as a direct-pay situation, knowing that the private driving instructional school has the duty to provide auxiliary aids including sign language interpreting services for education access, and is repeatedly discriminating by expecting the Deaf person to “bring a friend” to interpret the 8 week course. Or perhaps an attorney refuses to provide a sign language interpreter in a civil case, insisting that the Deaf witness self-hire an interpreter directly or depend on family members to interpret in order to participate alongside co-petitioners.

Profiting From Discrimination

Is it appropriate for one RID certified interpreter to recognize discriminatory practices and decline to participate, only to be replaced by other RID certified interpreters who believe it is outside the scope of practice for an interpreter to take a stand against direct discrimination from which the interpreter profits? What about referral agency responsibility to support equal access for the Deaf Community and ethical business practices of sub-contracting interpreters? Shouldn’t sign language interpreters and referral agencies be the first to recognize and reject profit from overtly discriminatory practices, modeling the daily efforts to educate the public on the requirements of the ADA law and equal access?

Input from an Attorney Interpreter Ally

Daryl Crouse is a well-respected, dedicated sign language interpreter and practicing attorney in Long Beach, California. He graciously agreed to provide his perspective on this issue. Here is an excerpt from his response:

I appreciate my colleagues’ initiative of this much needed discussion. Her work adds to and improves the profession. I believe we agree: it is wrong for a public accommodation to coerce a Deaf person into paying for our service in circumvention of the law.

Such that the Deaf person is coerced into paying for interpreting services; the Department of Justice has stated unequivocally a “public accommodation cannot coerce or attempt to persuade another adult to provide effective communication for the individual with a disability.”1 Thus, an ally would not stand silently while someone is coerced against their will to do something. Similarly, an ally takes their cue from others, careful to stand with and not in front of.

An alternate statement of the illustrative behavior may be: “An interpreter may refuse to accept an assignment when reasonably certain a public accommodation is passing on the cost of interpreting services to Deaf individuals as a surcharge. The interpreter should consult with the Deaf person to confirm their decision to self-pay is made [free of coercion.]” The expected behavior is directly linked to a specific fact. Linking to a specific fact provides clarity and would likely survive an enforcement challenge. Also, a dialogue with the Deaf person as to coercion and not the reason for their choice to self-pay the interpreter respects their right to privacy.

Standardizing Our Response

I would like to propose addressing this issue directly in our NAD-RID Code of Professional Conduct, and remove any ambiguity for RID certified sign language interpreters. It would be a very simple fix. Add a Business Practices Illustrative Behavior 6.9  Support ADA compliant payment and remove oneself from assignments in which a consumer is being directly charged for interpreting services in places of public accommodation, in compliance with CFR 28 Section 36.301(c). 

Share your thoughts. What is a professional, ethical response to a known, verified ADA payment violation?  What actions best support a social justice framework and outcomes?

Questions to Consider

1.  Why is it important that as sign language interpreters we standardize our responses? How does this benefit the Deaf Community? The public? The interpreting community?  What harm is done when we do not standardize our responses?
2.  Why is being complicit in discriminatory coercive practices incompatible with RID professional standards?
3.  Under what circumstances would you agree to direct payment arrangements with the D/HH/DB individual or group?

Related StreetLeverage Posts

Social Justice: An Obligation for Sign Language Interpreters?  by David Coyne

Social Justice: A New Model of Practice for Sign Language Interpreters? by David Coyne

Beyond Ethics: Rules Versus Values for Sign Language Interpreters by Amy Meckler

References

1 http://www.ada.gove/regs2010/titleIII_2010_regulations.htm#subpartc (last visited January 15, 2015)

Posted on 77 Comments

Educational Interpreters: Buck the Low Wage, No Credential Status Quo

 

A major challenge of educational interpreting is quality assurance. Shelly Hansen outlines how those in and around the educational setting can actively drive change to support higher minimum requirements for educational interpreters on a state by state basis.

Most sign language interpreters at some juncture in their career will provide interpreting services in an educational setting.  As mainstreaming with an interpreter has become a commonplace approach to educating deaf and hard of hearing kids, there is a consistent demand for educational interpreters.

While more common, twenty-two years after the ADA and the Individuals with Disabilities Education Act (both signed into law by President George H. W. Bush in 1990), there are still challenges faced by deaf children and their families in securing a Free and Appropriate Public Education.

One of these challenges is having access to a qualified, competent sign language interpreter.

Legislated Interpreter Standards

In the state of Washington, more than once in years past, bills have been put forward to establish standards for educational interpreters which would be phased in over time and require these sign language interpreters to demonstrate their proficiency thru national credentialing ie: NAD/RID/EIPA.   These bills historically have not been taken past committee.  This spring, during the recent 2012 WA legislative session, a group of three Deaf seniors from Snohomish High School successfully submitted HB 2765 for consideration.

WA HB 2765

Essentially this bill would have established a requirement for educational interpreters employed by school districts to successfully achieve minimum performance standards (as set by a professional educator standards board),  on one national written and performance assessment by the 2015-16 school year, and national interpreter certification (either RID or NAD certification) by the fall of 2018.  The full bill can be reviewed here.

The Challenge is Fiscal

Unfortunately, HB 2765 failed to reach the House floor.  Among the reasons cited for not taking it past committee was…budgetary.  WA state is currently experiencing a budgetary crisis, like many states in the aftermath of the Great Recession.   To put it bluntly, if you raise standards for educational interpreters, the cost for those professional services will most likely increase.

I saw a posting three weeks ago for an educational interpreter position in my area.  The qualification requirements include: HS diploma, proficiency in variety of sign systems and ASL with desired bilingual/bicultural Spanish skills.  The hourly rate is $13.78/hr.  In WA state the 2012 minimum wage is $9.04.  This is in dramatic contrast to the hourly rate of $85.08 which a freelance interpreter would need to be commensurate with the earnings of a public school teacher, as suggested by Theresa B. Smith, Ph.D in, Thinking About Money – Pulling Back the Curtain, 2009.

 Duty to Act

I would like to challenge educational interpreters in states that lack standard requirements for employment that include national credentialing to consider some kind of collective action.  Imagine a “Stay Home Tuesday.”  Promote utilizing available assessment tools (EIPA, RID).  Find your way to your legislators and state capitol.  Reject the status quo, work through your resistance and recognize the value of competency standards. Don’t ignore student efforts to secure a quality education.  Dialogue and join hands with colleagues on ways to expedite the establishment of professional standards in your state consistent with national credentialing trends.  Many sign language interpreters working in educational settings are already certified and their dedication and commitment to professionalism is to be commended. The students deserve to have qualified competent sign language interpreters commensurate with credentialed administrators, teaching staff, speech therapists, counseling staff etc…

Educational Interpreter Angst

Gina Oliva provides insight into the perspectives of educational interpreters in her recent Street Leverage article: Sign Language Interpreters in Mainstream Settings: Heartbroken and Gagged. In her post Gina suggests that  the collective voice of educational interpreters is the only hope deaf children have in remedying the many issues they confront in the classroom.  She suggests that sign language interpreters working in educational settings can do two very important things, one is to advocate for their students and the other is to bring a collective voice to the forefront in Deaf Education.  Advocating educational interpreter standards is a critical first step in support of positive student outcomes in mainstream settings.

State Requirements

Below is a listing of state requirements for educational interpreters.  It is difficult to find current information for each state and I would welcome updates from readers for missing or erroneous information on this listing compiled from various websites including the DOIT Center in Colorado.

Educational Interpreter Requirements

Alabama:  EIPA 3.5, RID Cert

Alaska: EIPA 4.0

Arizona: EIPA 3.5, RID Cert, NAD 3.0+

Arkansas: QAST 3/2 or 2/3, and written exam

California: EIPA 4.0, RID Cert, NAD 4+

Colorado: EIPA 3.5

Florida: RID Certification

Georgia: RID Certification, NAD 3+

Idaho: EIPA 3.5

Illinois: EIPA 3.0 (Note: 3.0 = Initial license, 3.5 = Standard License)

Indiana: EIPA 3.5, RID Certification, NAD 4+

Iowa: EIPA 3.5

Kansas: EIPA 4.0, QAST 4+,

Louisiana: EIPA 3.0

Maine: EIPA 3.5+

Michigan: EIPA 3.5 (may be upgraded to 4.0 pending review)

Minnesota: RID Certification, NAD 3+

Nebraska: EIPA 3.5, RID Certification, NAD 4+, QAST 4+

Nevada: EIPA 4.0, RID Certification, NAD 3+

New Jersey: EIPA 3.0, RID/NAD Certification

New Mexico: EIPA 4.0, RID Certification, NAD 3+

North Carolina: EIPA 3.5

North Dakota: EIPA 3.5, RID/NAD Certification

Ohio: RID Certification

Oklahoma: EIPA 3.5, RID Certification, NAD 4+

Pennsylvania: EIPA 3.5

South Dakota: RID Certification, NAD 3+

Texas: RID Certification/QAST

Utah: EIPA 3.5, RID/NAD Certification, QAST

Virginia: QAST 3+

Wisconsin: EIPA 3.5, RID Certification

Wyoming: EIPA 3.5+

At the End of the Day

I would like to encourage a collegial dialogue to assess whether sign language interpreters are complicit in keeping pay scales below professional wages by continuing to work without professional standards. Raising standards of interpreter competence has a direct impact on kids’ educational opportunities and access to academic and social content, which in turn affects their future opportunities as fulfilled, contributing citizens in a global market.