1. Working With Video Remote Interpreters Best Practices

2. Video Remote Equipment  Equipment and installation requirements

3. 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

4. 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)  Doctor’s rounds  When medical staff needs to talk to a patient who is hospitalized for an update on patient’s status  Discharge planning

5. Situations where VRI should not be used  Post operation  Equipment barriers (lead shielded rooms etc)  Patient is not coherent  Patient’s ability to use the VRI or patient’s 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.

6. 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 hearing 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, then the VRI is not appropriate

7. What the medical staff needs to know in order to facilitate communication through the VRI ~Always direct your comments to the deaf ~Always direct your comments to the deaf patient DIRECTLY patient DIRECTLY ~ Be aware that everything that is ~ Be aware that everything that is heard or seen by the interpreter will be interpreted 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 patient’s arm)

8. What you need to know What you need to know  Remember not to block the patient’s 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

9. 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

10. 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

11. Resistance to VRI  Some people have a fear of high tech equipment, but the VRI is actually quite simple to use, equivalent to turning on and off your TV set  Some people don’t like change and may feel it is too impersonal  There are legitimate reasons with certain situations when the VRI shouldn’t be used  The VRI equipment is usually housed in the IT dept and if they don’t keep track of where it is, it can be frustrating to try to find the equipment when needed  Sometimes there are technical difficulties and this could cause some resistance to using the equipment

12. The Difference between VRS & VRI VRS VRS Phone Relay Service Phone Relay Service Controlled by FCC Controlled by FCC Can only be located in approved Centers Can only be located in approved Centers VRI VRI Video to Video Service Video to Video Service No Controls, just partnership agreement No Controls, just partnership agreement Can be located in Interpreter’s home and follows HIPPA/RID confidentiality guidelines Can be located in Interpreter’s home and follows HIPPA/RID confidentiality guidelines

13. The Difference between VRS & VRI (continued) VRS VRS Variety of Topics Variety of Topics Qualified Interpreters, does not mean certified or trained to cover all topic matters Qualified Interpreters, does not mean certified or trained to cover all topic matters VRI VRI Specialized Topics Specialized Topics Interpreters should be RID Certified and had specialized training i.e. Medical Interpreters should be RID Certified and had specialized training i.e. Medical

14. 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

15. 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

16. 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

17. 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

18. 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

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

20. CDI  CDI and VRI interpreters don’t 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 to work in a 2 dimensional framework

21. 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

22. 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)

23. Questions and Answer Period  Thank you for attending our Workshop and we look forward to possibly working with you in a Video Remote Venue