Interpreting:

A Communication Bridge

Findings,

Proposals,

Plan of Action

From the Forum on Interpreting Services in the Health System in South Australia

24 June, 1999

Adelaide, South Australia

Foreword

The Migrant Women's Lobby Group (MWLG), founded in 1984 as a voluntary community organisation, has canvassed the issues, interests and concerns of a range of women in South Australia, particularly migrant women from non-English speaking backgrounds.

The MWLG provides a focus for women from all walks of life to share their gender and culture specific experiences, as well as their knowledge, expertise and understanding about the migration process, the value of multiculturalism and the importance of language and culture to the whole South Australian community.

The women of the MWLG see their roles as daughters, sisters, wives and mothers as central to their lives and the lives of their families and communities. Therefore, the MWLG advocates on those issues which affect women as individuals and as a group, as well as those which affect their families and their communities.

One such issue has been the adequate availability of and access to interpreting services in South Australia. Three reports on interpreting services have been released in the 1990s, yet anecdotal evidence continues to express concerns about access, funding, responsibility for provision, professional development for interpreters, grievance procedures and suspected cases of tragic consequences due to inappropriate interpreting.

As this matter has been regularly raised with members of the MWLG at meetings and at other consultations, it was decided to hold a Forum with the various stakeholders to identify strategies which would contribute to an improvement in the provision of interpreting services across the South Australian health sector.

The MWLG was successful in receiving a small grant from the Office of Multiculturalism and International Affairs (OMIA) for the planning and organisation of the Forum.

The Forum provided the opportunity to report on the survey conducted by the MWLG, to hear the perspectives of various stakeholders, to share experiences, to collate some strategies and proposals for the improvement of interpreting services in the health system in South Australia.

The Forum and this report are the results of the collaborative effort of many people, particularly the MWLG Interpreting Forum Team whose energy and commitment supported Monica Chiappe in facilitating the project.

The MWLG acknowledges the support of Community Benefits SA in printing and distributing the Report.

 

Rosa Colanero

Chairperson, Migrant Women's Lobby Group

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Acknowledgments

The Migrant Women's Lobby Group SA Inc would like to acknowledge the valuable contribution of many people in the organisation of the Forum and preparation of the Report, particularly:

• Dr Sev Ozdowski Chief Executive, Office of Multicultural International Affairs (OMIA), Department of Premier and Cabinet for the small grant and the official opening of the Forum;
• all the members of the MWLG Interpreting Forum Team; Koula Aslanidis, Gilda Campbell, Monica Chiappe, Rosetta Colanero, Irene Krastev, Sofia Mavrogeorgis, and Angela Nesci who contributed their time, experience and energy to our discussion and the formulation of proposals;
• Elizabeth Sloniec, for her assistance with editing;

 the speakers at the Interpreting Forum, namely:

• Russell Jackson, Manager, Telephone Interpreting Service,
• Robyn Gillies, Manager, Culturally Sensitive Services, Queen Elizabeth Hospital,
• Erricos Neophytou, Manager, Interpreting Translating Centre,
• Cheryl Appelkamp, South Australian Regional Officer, National Accreditation Authority Translators and Interpreters (NAATI);

and

the many services, service providers and members of the different communities who shared their experiences and encouraged us to undertake the research, organise the Interpreting Forum and prepare the Report.

Furthermore, the MWLG would like to acknowledge the contribution from Community Benefits SA towards the cost of the printing and distribution of the Report Interpreting: A Communication Bridge

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Index

 

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Introduction

 In responding to community concerns about access to and the provision of interpreting services in the health system in South Australia, the MWLG successfully applied for a grant from OMIA to hold a Forum to discuss and clarify the issue.

The MWLG Interpreting Forum Team was formed to oversee and support the project. Before commissioning its own study, the MWLG Interpreting Forum Team undertook a literature search. Member of the Team, Monica Chiappe, collated a review of past consultations and proposals about interpreting services in South Australia.

This review was used to inform the Interpreting Forum Team and provide the background information for the proposed research study.

Monica Chiappe facilitated the research and delivered the summary paper at the Forum. Her paper was based on the review of past consultations and the results of the questionnaire to health services and services providers, clients and community members.

The research found that consumers, services and service providers experienced ongoing difficulties in using interpreting services in South Australia. They identified problems with access and availability of interpreting services, shortage in funding for interpreting, difficulties with the Telephone Interpreting Service and a lack of professional development for interpreters.

Members of the community and individual consumers of interpreting services also experienced difficulties in giving appropriate feedback about the services they had used. The existing complaints mechanisms were considered inappropriate for people from non-English speaking backgrounds whose literacy and writing skills in English might be limited.

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Summary of Proposals

 Proposals about Funding

1.1 That the federal and state governments increase and target funding for interpreting services to clients from non-English speaking backgrounds in Nursing Homes, Aged Care and disability services.

1.2 That the federal and state governments increase and target funding for interpreting services to health related services such as domestic violence, counselling, mental health services etc.

1.3 That the federal and state governments undertake a review of the funding allocation to agencies that provide interpreting services to assess the effectiveness of service provision.

1.4 That the Migrant Women's Lobby Group continue to lobby the federal and state governments about the allocation of adequate funding for interpreting services in South Australia.

 Proposals about Access

2.1 That community health services and general services in the health system review and implement guidelines for the use of interpreting services.

2.2 That community health services, public hospitals and other relevant health services promote the availability of interpreters to the community and those in need of such a service.

2.3 That the Department of Human Services provide information about procedures for using interpreters to health service staff to encourage them to arrange interpreters for clients.

2.4 That interpreting services improve and update information to clients about cost and booking procedures, and provide the name of the interpreter attending the consultation.

 Proposals about Telephone Interpreting Service (TIS)

3.1 That TIS periodically assess the knowledge and skills of interpreters in different areas of their work.

3.2 That TIS conduct an annual evaluation into the quality of its service provision.

3.3 That TIS develop strategies for improving the waiting period over the phone.

3.4 That TIS review the two week waiting period for face to face interpreters.

 Proposals about Professional Development

4.1 That interpreting services ensure that interpreters receive adequate professional development in all aspects of their work, including interpersonal communication skills.

4.2 That quality assurance mechanisms be regularly monitored and evaluated by interpreting services.

4.3 That interpreting services implement an evaluation strategy which includes a procedure for complaints and feedback from clients.

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Plan of Action Summary

 The MWLG undertakes to

• send a copy of the report, highlighting the proposals from the Forum, to

  -Minister Ruddock as Federal Minister for Immigration and Multicultural Affairs

  -Premier Olsen and Minister for Ethnic Affairs

  -Minister Brown, Minister for Human Services;

• seek support from the Premier and Minister Brown in writing to Federal Minister Ruddock re increased and targeted funding for interpreting services in South Australia;
• send a copy of the report and seek support for the proposals from

  -Dr Sev Ozdowski, Chief Executive OMIA

  -Russell Jackson, Manager, Telephone Interpreting Service.

• send a copy of the report to hospital administrators, health services providers and other related services, highlighting the need for policy and guidelines on the use of interpreters;
• offer support in formulating policies and guidelines on the use of interpreters to hospital administrators, health services providers and other related services;
• encourage community health services, public hospitals and other relevant health services to promote the availability of interpreters and interpreting services to those in need of such a service in the community;
• send a copy of the report to the appropriate section of the Department of Human Services, highlighting the need for policy and guidelines on the use of interpreters, and requesting that the Department provide information about procedures for using interpreters to health service staff;
• send a copy of the report to interpreting services, requesting that they review their booking systems and costs;
• send a copy of the report to the SA branch of the Australian Medical Association (AMA), highlighting the need for policy and guidelines on the use of interpreters, and requesting that the AMA provide information to general practitioners and specialists about procedures for using interpreters;
• collaborate with Queen Elizabeth Hospital in seeking funding to produce a video on interpreting services.
• write to Federal Minister Ruddock, highlighting the concerns about TIS procedures and the impact on South Australian users;

Plan of Action Summary (continued)

 The MWLG undertakes to

• write to Mr Russell Jackson, highlighting the concerns about TIS procedures and the impact on South Australian users and seeking support and endorsement for the proposals in the Report;
• write to Premier Olsen, highlighting the concerns about TIS procedures and the impact on South Australian users, and asking him to write to Minister Ruddock about these concerns;
• encourage the users of interpreting services to register their concerns with TIS
• write to NAATI, seeking a review of the training and professional development needs of interpreters in the health system;
• write to interpreting service providers,

  -requesting that they review the training and professional development needs of interpreters in the health system;

  -seeking their support in the provision of debriefing sessions for interpreters in need;

  -seeking their support in the formulation and regular evaluation of quality assurance mechanisms;

  -requesting that they implement an evaluation strategy which includes a procedure for complaints and feedback from clients.

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Interpreting in the 90's

 Anecdotal evidence in the 1990s continued to express concerns about the provision of and access to interpreting services in South Australia.

The review of past consultations and the literature search conducted by the MWLG indicated that a number of issues continued to be of concern.

They included:

• provision of access to interpreting services
• responsibilities for the provision of Interpreting Services in the health system
• provision of interpreters in hospitals, dental clinics, general practitioner clinics, emergency departments of hospitals and x ray services
• understanding the booking system
• access to interpreters
• use of interpreting services and where to complain
• provision of funding for services to provide interpreters for consumers
• cost, (by both financial and social)
• waiting period over the phone for TIS

The results of the literature search and review of past consultations were used to formulate the survey which was sent to a number of health services, interpreting services providers, interpreters and community groups.

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MWLG May 1999 Survey Summary

 Summary of issues identified in interpreting services research included:

• Many Health Units reporting on the lack of appropriate funding for interpreters
• After hours and emergency calls, being made more responsive and less costly by interpreting services
• Health units and workers needing feedback mechanisms between units and interpreting agencies
• Inadequacy of guidelines in some community health services on when to use an interpreter or who makes the final decision
• Many health services and workers reporting that the waiting period is not very practical with clients in crisis (need for on-site interpreters)
• Frequently long waiting periods for TIS over the phone
• Difficulties with the limitations imposed by the quota system for on site interpreting by TIS
• Appropriate complaint mechanisms to the interpreting agencies, government and non-government agencies not readily available or accessible. Consumers do not know where to complain, what their rights are in accessing interpreting services and how the booking system works.
• Lack of appropriate support and de-briefing systems for interpreters. Interpreting agencies should support a debriefing mechanism.
• Many consumers reporting that services refused to provide an interpreter because of the cost implications for the services
• Lack of training, by interpreter agencies, for interpreters on different topics or updated information about health and welfare issues
• Limiting the interpreter's role by the policy of interpreting exactly what is said. Interpreters often cannot explain or clarify things &endash; vital and specific information is lost in the translating process
• Many health workers and other workers in the health system report that interpreters often translate "word for word" which leads to distortion of the true meaning of what has been said on either side, resulting in out of context translation

 Summary of issues identified in interpreting services research included:

• Interpreters in sign language for deaf people from NESB communities are very limited. This makes it very difficult for appropriate services to be provided
• Interpreters in some languages like for eg; Hungarian, Khmer etc, are often not available when needed and services need to be booked a long time in advance
• Many consumers and NESB community members reported that hospitals, the mammography clinic, the cervical screening clinic encourage clients to bring relatives or friends to interpret because of the cost as there is no funding for interpreting services. Sometimes even when there is funding available administration staff is not trained in the necessity of using interpreters. Asking the client if an interpreter is needed is not part of the booking system

These survey results were tabled, discussed and endorsed at the Forum.

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Forum Program

The proceedings of the day began with Dr Sev Ozdowski, Chief Executive, Office of Multicultural International Affairs, officially opening the Forum. He acknowledged the need to value and promote languages other than English and advocated that the provision of and access to interpreting services was an important social and equity issue in the community. He looked forward to receiving the report.

Ms Monica Chiappe, Community Liaison and Health Worker (ACCHS - Dale St Health Centre) gave a presentation which included a review of past consultations on interpreting services (1991-9) and the results of the survey undertaken by the MWLG in May 1999.

A panel of speakers addressed the Forum, including: Mr Russell Jackson, Manager, Telephone Interpreting Service, Melbourne; Ms Robyn Gillies, Manager, Culturally Sensitive Services, Queen Elizabeth Hospital; Mr Erricos Neophytou, Manager, Interpreting Translating Centre, OMIA and Ms Cheryl Appelkamp, Regional Officer, NAATI.

After the panel presentations, an Open Forum with questions and general discussion followed.

In the afternoon, issues and strategies were discussed and proposals formulated at a workshop session.

Approximately 70 people attended the Forum and feedback from participants about the day was very positive. Participants discussed the areas that were identified in the questionnaire research and contributed their knowledge, experience and expertise to the strategies and proposals.

The issues raised in the research and at the Forum were grouped into four main categories:

• Funding
• Access
• Telephone Interpreting Service
• Professional development for interpreters

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Interpreting Issues

1. Funding

Summary of discussion

The lack of funding in some health services for the provision of interpreting to their clients emerged as a major concern.

Participants indicated there is confusion amongst health service providers and the general community about funding arrangements: whether the funding is given by the state or federal government; whether the funding is allocated as part of the core funding or as an additional allocation specifically for provision of interpreting services; and how the quota system of interpreter provision operates.

Comments were made that health service providers are often given funds for their core business. For some health service providers, this includes monies for language services. The reality of limited funding and the undervaluing of language services can mean that languages services are not seen as core business so that funds are not directed in that area.

Some health service providers are funded separately for language services and use these funds for this purpose. This was thought to be an efficient method.

 Range of comments:

• Complexity of illness determines funding allocation (case-mix), with no consideration given to interpreting needs of clients.
• When funding levels remain the same and cutbacks are made to services, interpreting services usually miss out.
• Need to raise awareness of the government and health services to provide more funding specifically for interpreting services
• The state government should provide funding for a 24 hour interpreting service in line with what is provided in other states.
• Statistical data should be collected to validate the increase in funding for interpreting services.
• If health care professionals cannot communicate with their clients through a lack of interpreting services, quality of care cannot be assured and duty of care is compromised.

 Proposals about Funding

 1.1 That the federal and state governments increase and target funding for interpreting services to clients from non-English speaking backgrounds in Nursing Homes, Aged Care and disability services.

1.2 That the federal and state governments increase and target funding for interpreting services to health related services such as domestic violence, counselling, mental health services etc.

1.3 That the federal and state governments undertake a review of the funding allocation to agencies that provide interpreting services to assess the effectiveness of service provision.

1.4 That the Migrant Women's Lobby Group continue to lobby the federal and state governments about the allocation of adequate funding for interpreting services in South Australia.

 Action

The MWLG undertakes to

• send a copy of the report, highlighting the proposals from the Forum, to

  -Minister Ruddock as Federal Minister for Immigration and Multicultural Affairs

  -Premier Olsen and Minister for Ethnic Affairs

  -Minister Brown, Minister for Human Services;

• seek support from the Premier and Minister Brown in writing to Federal Minister Ruddock re increased and targeted funding for interpreting services in South Australia;
• send a copy of the report and seek support for the proposals from

  -Dr Sev Ozdowski, Chief Executive OMIA

  -Russell Jackson, Manager, Telephone Interpreting Service.

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Interpreting Issues

2. Access

Summary of discussion

Participants felt very strongly that interpreting services are a basic human right and that quality interpreting by professional interpreters and efficient interpreting services are fundamental for people from non-English speaking backgrounds to obtain quality health care. This issue was part of the broader concern about gaps in health services for disadvantaged groups, especially migrants and refugees.

Community representatives, clients of the health system and health care workers raised serious issues about the access to interpreting services. The reasons given by staff to clients for not providing interpreters is the lack of sufficient funding or that they are not aware of the provider of interpreter services.

In particular, concerns were expressed about interpreting services for aged care, home care, nursing home and elderly people with disabilities not being able to access appropriate services and that, in these circumstances, people were made more isolated without being able to describe symptoms or communicate their feelings and anxieties.

Other implications for clients if they do not get access to interpreters is the danger of taking drugs and treatment without an understanding of the purpose of the treatment or side effects.

 Range of comments

• In some health services and hospitals, staff were unaware of how to access interpreters eg procedures for booking interpreters.
• Some health services still needed training on awareness and acceptance of cultural difference and use of interpreters.
• The failure in providing access to interpreters to clients is a form of indirect discrimination.
• People need to know their rights and how to get access to services,
• Clients need to know what options are available to them.
• Services need to use friendly information provision in the form of multilingual posters, pamphlets and signs.

 Proposals about Access

2.1 That community health services and general services in the health system review and implement guidelines for the use of interpreting services.

2.2 That community health services, public hospitals and other relevant health services promote the availability of interpreters to the community and those in need of such a service.

2.3 That the Department of Human Services provide information about procedures for using interpreters to health service staff to encourage them to arrange interpreters for clients.

2.4 That interpreting services improve and update information to clients about cost and booking procedures, and provide the name of the interpreter attending the consultation.

 Action

The MWLG undertakes to

• send a copy of the report to hospital administrators, health services providers and other related services, highlighting the need for policy and guidelines on the use of interpreters;
• offer support in formulating policies and guidelines on the use of interpreters to hospital administrators, health services providers and other related services;
• encourage community health services, public hospitals and other relevant health services to promote the availability of interpreters and interpreting services to those in need of such a service in the community;
• send a copy of the report to the appropriate section of the Department of Human Services, highlighting the need for policy and guidelines on the use of interpreters, and requesting that the Department provide information about procedures for using interpreters to health service staff;
• send a copy of the report to interpreting services, requesting that they review their booking systems and costs;
• send a copy of the report to the SA branch of the Australian Medical Association (AMA), highlighting the need for policy and guidelines on the use of interpreters, and requesting that the AMA provide information to general practitioners and specialists about procedures for using interpreters;
• collaborate with Queen Elizabeth Hospital in seeking funding to produce a video on interpreting services.

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Interpreting Issues

3. Telephone Interpreting Service (TIS)

Summary of discussion

Almost all participants expressed concerns about the Telephone Interpreting Service (TIS). People related their experiences with delays in being connected to an interpreter and TIS interpreters not having sufficient knowledge of medical terminology.

Other concerns were with the booking system, the quota imposed on providing interpreting to people in the community, and the two week booking in advance required for face-to-face interpreters which is problematic when community members are in an emergency situation.

These difficulties have increased since TIS moved interstate, especially the capacity to respond quickly. Even when clients want to complain or raise an issue, they are reluctant to do so because there is no office in South Australia.

 Range of comments

• Many service providers have limited knowledge of the existence of TIS.
• Limitations imposed by Telephone Interpreting Service caused serious difficulties eg two week booking time.
• Many general practitioners and specialists do not provide interpreting services to their clients.
• Lack of face-to-face interpreting services in rural areas of SA.
• TIS based in Melbourne does not have the knowledge of SA interpreters and SA conditions.

 Proposals about Telephone Interpreting Service (TIS)

3.1 That TIS periodically assess the knowledge and skills of interpreters in different areas of their work.

3.2 That TIS conduct an annual evaluation into the quality of its service provision.

3.3 That TIS develop strategies for improving the waiting period over the phone.

 Action

The MWLG undertakes to

• write to Federal Minister Ruddock, highlighting the concerns about TIS procedures and the impact on South Australian users;
• write to Mr Russell Jackson, highlighting the concerns about TIS procedures and the impact on South Australian users and seeking support and endorsement for the proposals in the Report;
• write to Premier Olsen, highlighting the concerns about TIS procedures and the impact on South Australian users, and asking him to write to Minister Ruddock about these concerns;
• encourage the users of interpreting services to register their concerns with TIS.

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Interpreting Issues

4. Professional Development for Interpreters

Summary of discussion

A large number of participants commented on the need for professional development for interpreters in areas of up-to-date medical terminology, interpersonal communication skills and changes in the health system.

The need for interpreters to have debriefing sessions, especially when dealing with issues of abuse, trauma, mental health etc., was raised as an area which should be addressed.

Bilingual workers commented that they increasingly saw themselves as having an active role in receiving complaints, comments and feedback from their own communities and individual clients in relation to the problems they confront eg booking an interpreter, not knowing where and how to make complaints, and the lack of participation by clients in the evaluation of interpreting services and health services.

 Range of comments

• Interpreters' knowledge of the health system was very poor.
• Some interpreters do not have good interpersonal communication skills and/or a friendly approach with clients.
• The issue of debriefing is a health and safety issue and interpreting services must take responsibility in this area.
• All interpreters are employed on a casual basis only, so they feel insecure and need to look for other employment.
• Interpreters do not earn enough to provide for the cost of their own training.
• TIS does not train its interpreters.
• OMIA does some professional development with interpreters and arranges debriefings.
• Community groups and clients must be included in reviews of interpreting services.
• Interpreting services have to take responsibility for the standard and quality of service delivered.

 Proposals about Professional Development

4.1 That interpreting services ensure that interpreters receive adequate professional development in all aspects of their work, including interpersonal communication skills.

4.2 That quality assurance mechanisms be regularly monitored and evaluated by interpreting services.

4.3 That interpreting services implement an evaluation strategy which includes a procedure for complaints and feedback from clients.

 Action

The MWLG undertakes to

• write to NAATI, seeking a review of the training and professional development needs of interpreters in the health system;
• write to interpreting service providers,

  -requesting that they review the training and professional development needs of interpreters in the health system;

  -seeking their support in the provision of debriefing sessions for interpreters in need;

  -seeking their support in the formulation and regular evaluation of quality assurance mechanisms;

  -requesting that they implement an evaluation strategy which includes a procedure for complaints and feedback from clients.

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Conclusion

 There was clear evidence presented by participants at the Interpreting Forum that the provision of interpreting services throughout the South Australian health system needed to be improved. Furthermore, the information about the availability of the service to people from diverse cultural and linguistic backgrounds needed to be disseminated more effectively.

Initiatives suggested at the Forum included an evaluation strategy incorporating client feedback, professional development for interpreters and increased and targeted funding for language services to health service providers. To be used effectively, interpreting services need to be integrated into the wider health system as part of the policies, implementation plans and budget targets of the different services in the government sector.

It is important that the gaps in the availability of interpreting services in the health system and the lack of adequate funding for the provision of such services to the community be addressed by the appropriate federal and state government departments as a priority. Access to interpreters is a right of people from non English speaking backgrounds in the community for equal access to the health system.

The health care of people from non English speaking backgrounds, especially newly arrived migrants and refugees, is seriously at risk if their need for appropriate language services is not met.

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References

• Migrant Women's Lobby Group Research Report, 'Interpreting Services in the Health System', 1999
• Monica Chiappe The Review of Interpreting Services 1991-9
• SA Health Commission Health Units, Review of the funding of interpreting services. Language Services Baseline Funding Project"- 1997
• Joint Commonwealth/State/Territory Population, Immigration & Multicultural Research Program, Usage and Accessibility of Interpreters and Translators 1997

 

INTERPRETING

Hearing…

Listening…

Caring…

Responding…

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