Module 7: Cultural Competency What is culture Module 7: Cultural Competency What is culture? How does it influence a medical encounter? What is the role of the Culture Broker? How to identify and navigate Cultural Bumps?

Definition of culture: Culture is a shared set of belief systems values practices assumptions which determine how we interact with and interpret the world.

Culture in Medical Encounters Culture of patient Culture of doctor Culture of interpreter Culture of health care system Interpreter must be aware of all cultures present to facilitate communication

Nonverbal Communication Behavior varies across cultures: Voice – tone, pitch, volume Gestures and posture Eye contact Personal space and physical contact Punctuality

Culture and Power Dynamics Different cultures = different power dynamics among individuals Between doctor and patient Between younger person and elder Between family members Between man and woman

Medicine Across Cultures Biomedicine approach vs. popular/traditional approaches Paying for care and insurance

Interpreter as Culture Broker Interpreters must look at situations within the appropriate cultural framework and use this to facilitate communication Cultural competency = understanding someone’s actions from their own point of view Interpreters look out for “cultural bumps”

Navigating Cultural Bumps A cultural bump occurs when cultural differences create a barrier to understanding between patient and provider Interpreter can help overcome cultural bumps by: Awareness of situation – look for nonverbal clues Understanding cultural causes of bump Following rules for intervening Providing brief explanation to facilitate understanding Maintaining transparency Returning to Conduit role as quickly as possible

Module 8: Legislation and Regulations behind Medical Interpreting What are the major laws and regulations behind medical interpreting? What are the laws regarding abuse reporting and informed consent that interpreters must be aware of?

Title VI of the Civil Rights Act of 1964 Commonly referred to as “Title VI,” this section of the Civil Rights Act reads: No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance. In other words, this law prohibits all public and private health care providers who receive any type of federal assistance from conducting their programs in a way that discriminates or limits access on the basis of race, color, or country of origin.

What does Title VI mean for medical interpreters? “Country of origin” includes spoken language Federal assistance includes: - Grants - Use of equipment - Training - Accepting Medicare/Medicaid funds as payment

Executive Order 13166 Titled “Improving Access to Services for Persons with Limited English Proficiency” Signed by Clinton in 2000 Increases Federal oversight to ensure that recipients of Federal financial assistance (including hospitals) are providing meaningful access to their LEP (Limited English Proficiency) applicants and beneficiaries Information from lep.gov

CLAS Standards National Standards on Culturally and Linguistically Appropriate Services (CLAS) developed in 2000 Principal Standard:   Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.

Bottom Line Hospitals and other health care providers MUST provide qualified and trained interpreters at NO COST to patients It’s the LAW

HIPAA and Medical Interpreters HIPAA = Health Insurance Portability and Accountability Act Main purpose = protect patient privacy Helpful to understand HIPAA form as may have to sight translate Bottom Line for Interpreters = Maintain Confidentiality Do not share any info that could identify patient Inform parties of confidentiality during pre-session Only exceptions: Patient gives consent to disclose Mandatory reporting

Mandatory Reporting of Abuse Any person who knows or has reasonable cause to suspect abuse of child or ‘vulnerable adult’ must report to FL Abuse Hotline Vulnerable adult = age or disability Hospital personnel = Mandatory Reporters [- does this apply to freelance interpreters?] – must provide name Failure to report = 3rd degree felony Adult abuse: may not be reported without informed consent Exception: hospital personnel must report life-threatening injury indicating act of violence Source: http://www.myflfamilies.com/service-programs/abuse-hotline/definitions-for-reporting-abuse

Informed Consent and the Interpreter ? – is this mainly just confidentiality rules? Couldn’t find much info

Learning Strategies Vocabulary building Learning words in context better than memorization Study prefixes and suffixes Prepare as much as possible before appointment Review new words and concepts after appointment

Module 9: Medical Interpreter Certification What is the value of certification for interpreters and institutions? How do you become a certified medical interpreter? What is the importance of continuing education for interpreters?

Medical Interpreter Certification Interpreters: Why become a certified medical interpreter? Institutions: Why hire certified medical interpreters? Certification Process: Meet basic requirements Pass Written Exam Pass Oral Exam 2 Organizations provide Certification: National Board of Certification for Medical Interpreters (NBCMI) Certification Commission for Healthcare Interpreters (CCHI)

Comparing CCHI and NBCMI Both are nationally recognized and equally accepted Cost is about the same ($450-$500 for whole process) Written and Oral Exams very similar Main deciding factor for interpreter Testing dates Locations Languages available

CCHI vs NBCMI Spanish, Mandarin, Arabic Alternative certification available for others (just written) Written Exam focuses slightly more on managing interpreting encounter Small Simultaneous component on Oral Exam Spanish, Russian, Mandarin, Cantonese, Korean, Vietnamese Alternative certification for others in the works Written Exam focuses slightly more on medical terminology No Simultaneous on Oral Exam 40 hours approved Medical Interpreter Education required by both Additional requirements vary slightly & include - proof of language proficiency - professional experience - general education

Continuing Education Required to maintain certification Important to continue improving skills & stay current Can be earned through Attendance of professional interpreters’ conferences/conventions In-person workshops Online courses Providers: DLMIT, IMIA has complete listing