In Person and Video Remote Interpreting

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In Person and Video Remote Interpreting

• Know your Facts

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Presented by

• Rachel Spillane
• M.Ed., CSC, OTC
• Director of Deaf Out Reach Services

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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

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Video Remote Equipment

• Equipment and installation requirements

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Steps of the VRI System
Step One The hospital personnel phones the VRI
agency to request the VRI service
Step Two The agency then contacts the VRI
interpreter with the request
Step Three The VRI interpreter places the call
to the hospital contact person to ensure the
equipment is in place and is ready to be used
Step Four The Interpreter then initiates the VRI
connection
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The Difference between VRS VRI

• VRS
• Phone Relay Service
• Controlled by FCC
• Can only be located in approved Centers

• VRI
• Video to Video Service
• No Controls, just partnership agreement
• Can be located in Interpreters home and follows
  HIPAA/RID confidentiality guidelines

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The Difference between VRS VRI (continued)

• VRS
• Variety of Topics
• Qualified Interpreters, does not mean certified
  or trained to cover all topic matters

• VRI
• Specialized Topics
• Interpreters should be RID Certified and had
  specialized training i.e. Medical

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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.

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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

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Cost of running VRI

• Over head costs of hook up, T1 lines, phone
  lines, gate 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

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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 hasnt had the
  experience of requiring interpreting services
  (Reinforcement is Key)

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VRI Guidelines
Possible Inappropriate VRI Situations
Technical Difficulties
Visual Barriers
Cognitive Barriers
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Technical Difficulties

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

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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.

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Visual Barriers

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

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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.

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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.

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The next few slides are examples of what to
include in a training power point to the hospital
staff
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Situations where the VRI is appropriate

• Emergency Room-admissions information for triage
  to 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)
• Doctors rounds
• When medical staff needs to talk to a patient who
  is hospitalized for an update on patients status
  
• Discharge planning

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Situations where VRI should not be used

• Post operation
• Equipment barriers (lead shielded rooms etc)
• Patient is not coherent
• Patients ability to use the VRI or patients
  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.

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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

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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 patients arm)

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What you need to know

• Remember not to block the patients 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

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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

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Advantages of VRI

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

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The following slides are examples of what you
would use to train your interpreting staff
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The Interpreting Challenge

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

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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

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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

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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

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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

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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

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CDI

• CDI in a mental health setting need to be aware
  of their signing affect so as not to increase the
  patients anxiety or emotional state
• CDI can determine if an onsite hearing
  interpreter would be better suited for the
  situation at hand

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CDI

• CDI and VRI interpreters dont 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

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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)

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The following slides give examples of how you
train and empower your consumers i.e Deaf Patients
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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)

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How to Advocate for Yourself
Ask the VRI interpreter the following
questions A) What is interpreters 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
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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?

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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