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This article examines current issues in the use of interpreting services, as experienced by refugees and asylum seekers in the UK. The paper begins with a review of relevant literature on interpreting services and relates it to the service context and the specific needs of refugees and asylum seekers. There follows a discussion of a small‐scale research project carried out with interpreters working in these services. Recommendations are made which include the need to educate all three parties (the professional employing the interpreter, the interpreter and the client) in not only best practice and practical techniques of working with interpreters, but also broader issues such as the complexity of the interpreting process, the importance of establishing trust, competing agendas and negotiation of meaning that are implicit in the interpretation process.

This article reports the outcomes of a study on communication support, commissioned to develop a borough‐wide strategy in 2003 by the London Borough of Tower Hamlets.The research stems from a recognition of communication as a key to successful delivery of public services and enhancement of a multicultural community.The focus is on ‘communication’ (rather than ‘language’), since it captures issues beyond the exchange of information through words: interpersonal interactions and relationships, techniques and modes of organising information exchange. Language is a key component within the broad ambit of communication mechanism and skills. Hence interpretation and translation are perceived as models of communications support alongside advocacy, integrated team, multilingual professional team, family/friends and minors, supported language, symbols and signs, and Plain English.While engaging in the debate and highlighting some of the broader issues concerning communication support services, the focus is on the following main issues:• policy frameworks and guiding principles in communication support• methods and techniques for needs assessment, monitoring and evaluation of communication support• communication support provision in Tower Hamlets including quantifying need, actual state of provision and users' perceptions.Probably among the first of its kind, the strategy draws on existing knowledge and good practice to develop a common framework for public services in Tower Hamlets. It is believed that it will serve a pioneering role in co‐ordinated existing and developing coherent approaches to communication support.

The aim of the research was to identify factors related to the increased cost of providing health services to clients from a non‐English speaking background (NESB), using a cross‐sectional analysis of the administrative records of clients using community health services in the Northern Metropolitan region of Melbourne for the 2001/2002 financial year. The higher cost of providing services to NESB clients was influenced by four factors: increased consultation time, group attendance to an appointment, increased interpreting cost and the type of service provider. Family members and multilingual staff play a significant role in providing informal interpreting services or low‐cost support for NESB consultations, and these activities should receive appropriate support. Additional funding is needed to support interpreting requirements when dealing with the health needs of NESB clients. Vertical funding equity would provide a better solution than the current horizontal equalisation funding.

Women with little-to-no English continue to have poor birth outcomes and low service user satisfaction. When language support services are used it enhances the relationship between the midwife and the woman, improves outcomes and ensures safer practice. However, this study has shown a reluctance to use professional interpreter services by midwives. This study aims to understand the experiences of midwives using language support services.

A maximum variation purposive sampling strategy was used to recruit midwives (N = 12) to a qualitative, semi-structured interview study. Data were analysed using thematic analysis.

Four themes were generated from the data analysis with a central organising concept of “Navigating Care Without Language”. These themes were: “Continuity as Key”, “Facilitating Tools”, “Networks of Support” and “Innovative Planning”. Each of these themes had between three and four sub-themes. It was found midwives are keen to support women with language barriers. However, support can be difficult due to the unavailability of equipment and resources; lack of continuity (of interpreter and midwife); inability to plan for the acute care of women who require interpreter services; and the system not being accessible enough to women who require language support services, thus causing them to fall through the net.

Continuity of carer appears to be a protective factor due to the flexibility, relationship and continuum of support. This study will aid the development of education for undergraduate, post-graduate and practising midwives. It will also inform policymakers working to improve the service offered to women who speak little-to-no English.

Working across languages is playing an increasingly important role in the delivery of mental health services, notably through psychotherapy and psychological therapies. Growing awareness of the complex processes that ensue in working across languages, including the presence and role of an interpreter, is generating new conceptualisations of practice, but there is a need now to evidence how these impact on service users. The paper aims to discuss these issues.

This paper discusses the model for working with interpretation developed by Mothertongue multi-ethnic counselling service, which conceptualises the therapeutic process as working within triangular relationships consisting of service user, therapist and interpreter. Second, the paper discusses the qualitative, practice-near methods applied in, and findings from a pilot study to evaluate the interpreter's role.

Three patterns of response to interpreters were identified: negative impacts on the therapy, the interpreter as conduit for therapy and the therapist and interpreter jointly demonstrating a shared enterprise. It is concluded that the method and findings of the pilot justify a larger study that will further evaluate the experiences of service users and continue to develop and test conceptualisations for best practice.

Working across languages is now recognised as an increasingly important aspect of therapy in contexts where migration has created new demographics. This paper contributes to the discussion of working therapeutically with people with mental health difficulties across languages. Its originality lies, first, in the discussion of a new clinical approach to working with interpreters, and second in the methods used to access the views of service users about their experiences of interpreters.

Approximately 42 million people worldwide are displaced due to persecution, war or natural disaster (UNHCR, 2008). Many seek refuge in countries far from their own. Where host countries supply refugee mental health services, these services rely heavily on the work of interpreters. Despite interpreters being exposed to significant client distress, little attention has been paid to the impact of mental health interpreting on the well‐being of interpreters themselves. This study set out to build on limited previous work in this area.A total of 157 interpreters contracted by Glasgow Translating and Interpreting Service, UK, were surveyed in April 2007. Responses were analysed using grounded theory analyses. Of the 18 interpreters who responded, 56% reported having been emotionally affected by mental health interpreting, 67% reported that they sometimes found it hard to put clients out of their minds and 33% reported that interpreting for clients with mental health difficulties had had an impact on their personal life. Respondents experienced a range of emotions in relation to their work, including anger, sadness, hopelessness and powerlessness, and 28% reported sometimes having difficulty moving onto their next job due to distress associated with a previous client. These findings are discussed in relation to good practice guidelines.

This article explores issues of trust in narratives of interpreted consultations in primary health care.

The paper is based on empirical data from a qualitative study of accounts of interpreted consultations in UK primary care, undertaken in three north London boroughs. In a total of 69 individual interviews and two focus groups, narratives of interpreted consultations were sought from 18 service users, 17 professional interpreters, nine family member interpreters, 13 general practitioners, 15 nurses, eight receptionists, and three practice managers. The study collected and analysed these using a grounded theory approach and taking the story as the main unit of analysis. It applies a theoretical model that draws on three key concepts: Greener's taxonomy of trust based on the different “faces” of power in medical consultations; Weber's notion of bureaucratic vs traditional social roles; and Habermas' distinction between communicative and strategic action.

Trust was a prominent theme in almost all the narratives. The triadic nature of interpreted consultations creates six linked trust relationships (patient‐interpreter, patient‐clinician, interpreter‐patient, interpreter‐clinician, clinician‐patient and clinician‐interpreter). Three different types of trust are evident in these different relationships – voluntary trust (based on either kinship‐like bonds and continuity of the interpersonal relationship over time, or on confidence in the institution and professional role that the individual represents), coercive trust (where one person effectively has no choice but to trust the other, as when a health problem requires expert knowledge that the patient does not have and cannot get) and hegemonic trust (where a person's propensity to trust, and awareness of alternatives, is shaped and constrained by the system so that people trust without knowing there is an alternative). These different types of trust had important implications for the nature of communication in the consultation and on patients' subsequent action.

The methodological and analytic approach, potentially, has wider applications in the study of other trust relationships in health and social care.

Quality in the interpreted consultation cannot be judged purely in terms of accuracy of translation. The critical importance of voluntary trust for open and effective communication, and the dependence of the latter on a positive interpersonal relationship and continuity of care, should be acknowledged in the design and funding of interpreting services and in the training of both clinicians, interpreters and administrative staff.

This is the first study in which interpreted consultations have been analysed from a perspective of critical sociology with a particular focus on trust and power relations.

In an effort to address health care disparities, U.S. laws mandate that health care organizations provide free language interpreting and translation anytime a patient and health care provider cannot communicate in the same language. The heretofore absence of legislative and professional oversight in health care interpreting allows for anyone to interpret. A qualitative study was conducted to understand the conditions and practices of bilingual staff who interpret as a secondary part of their job in community health clinics.

Four focus groups were conducted as part of a study on shared decision-making during interpreted medical visits in a busy, urban clinic serving a large number of limited English proficient (LEP) patients. The focus groups were designed to understand the process of interpreting and how interpreters influence medical decisions between LEP patients and their health care providers. To understand the interpreting process from multiple perspectives, one focus group was conducted with users of interpreters – monolingual health care providers (N=6), two with Spanish speaking men (N=10) who were experienced with interpreted health visits, and one with bilingual staff (N=5) who interpret as an ad hoc feature of their job, also known as dual-role medical interpreters.

Dual-role interpreters use different styles while interpreting what is communicated between health care providers and patients. In some cases, they provide near word-for-word interpretation of what is said. In other cases, they summarize and or paraphrase multiple sentences, seek clarity through questions, and deconstruct culturally laden and technical terms. In still other cases, dual-role interpreters combine interpretation styles within a single interactional exchange. Each of the three major styles of interpreting has advantages in medical settings. Specific style is influenced by health care provider preference, interpreter–health care provider trust and familiarity, and interpreter medical knowledge. Interpreters are challenged by the patients’ dialects, educational level, provider personalities, gender issues, and out of clinic relationships with the patients. Contextual conditions and contingencies of reinforcement contributed to varying methods of interpretation. These conditions included organizational policies, language and bilingual communication, and social relations with both the health care providers and the patients.

These findings demonstrate the complexity of medical interpretation and the critical involvement of health care providers and bilingual staff in facilitating interpreted encounters. Findings suggest the need for training both health care providers and interpreters and possible change in reimbursement for services.

The purpose of this paper is to draw attention to the important and unique challenges that arise when using interpreters while conducting psychotherapy with forced migrants who have experienced a range of human rights abuse.

The paper employs a practice‐based evidence methodology that offers guidance to both clinicians and researchers.

Working with interpreters in the clinical setting is often a challenging and complex process for which mental health professionals are rarely prepared. This paper outlines key strategies to address these challenges and limitations.

Empirically‐based research is lacking and is certainly warranted.

It is the responsibility of programs, training sites, supervisors, and institutions to help teach how to work with interpreters.

This paper addresses how to navigate the key issues that arise through the use of interpreters in a mental health setting with forced migrants, including: initiating a therapeutic relationship with an interpreter; common issues that arise around language; setting the therapeutic frame; and addressing boundaries; acknowledging the role of culture, transference, counter transference, and vicarious trauma; screening to assess competence; training to orient interpreters to clinical work with forced migrants; in vivo feedback; assessments; and an appropriate place to process their experience.

The COVID-19 pandemic significantly disrupted the lives of the deaf community, and the implementation of restrictions on face-to-face meetings resulted in the trial introduction of video remote interpreting (VRI) in a secure psychiatric setting. This study aims to use a qualitative research paradigm to explore user experiences to inform potential future technological developments in this area.

Twelve deaf patients and three interpreters took part in structured face-to-face interviews and discussed their experiences of the use of VRI, with the results being assessed using thematic analysis.

Seven main themes were identified: resource availability, ease of use, technical issues, misunderstandings, medium secure-specific issues, preferences and human factors. All participants agreed that they did not like the VRI technology in the health-care environment in its current format, and their main concern was the difficulty in understanding the information being communicated. It was considered that this had the potential to incur potentially serious medico-legal and safety implications for both staff and patients alike.

This study has provided detailed users’ feedback about the potential future use in this communication tool and can help guide service developers to review the technology design to tailor it towards the users’ needs. While the existing technology is not currently suitable for this deaf population, particularly because of the potential for error, there is potential scope for further research in this area.

The COVID-19 pandemic provided a unique opportunity to explore the potential use of VRI for a deaf patient population within a secure psychiatric setting, where such technology is unlikely to have otherwise been used.