Toward Equity:
Interpreter Training Study

• Study Participants' Area (secure)

Publication:
Observation-Supervision in Mental Health Interpreter Training

Problems Regarding Interpreter Training
Interpreters typically define their work as "facilitating communication between hearing and deaf people" or some variant thereof. But most interpreter training programs (ITPs) reduce this complex task into instruction on two topics - language and culture. Experienced interpreters and interpreter instructors know that true cross-cultural, cross-linguistic communication facilitation involves factors that lie outside target and source language (and culture) per se but the field has no adequate way to convey such complexities. It is why ITP teachers or interpreter mentors rarely answer a student's translation question ("how do you sign __________") or questions about ethical behavior ("what would you do if _______") with a direct answer. Interpreter trainers and mentors usually will reply "it depends" and inquire about more contextual information before they can answer. Experienced interpreters and interpreter trainers know there is a lot more to the work than just language and culture but students in ITPs and less experienced working interpreters cannot because this is not readily taught except in a situational "it depends" fashion.

A larger problem that comes from this singular focus on language and culture and the lack of including other elements in the consideration of interpreting work, is the approach toward training interpreters as generalists. Currently, interpreters are trained as if language is language and context is context. For those who have worked in specialized areas such as mental health, this is a dangerous perception. Interpreters need to understand the meaning and the implications of how psychologists, psychiatrists, emergency room staff, therapists, etc., use language in ways that are profession-bound and/or often different than the general public means even when using the same words and phrases.

While the current literature in the interpreting field seems to suggest a perception that interpreting is indeed a practice profession (Dean & Pollard, 2001), the teaching and training of interpreting professionals paints a very different picture. The schema or method interpreters use to talk about their work is insufficient to capture the many nuances of cross-culture, cross-language facilitation across the varied settings in which interpreters are employed. The perception that a given target or source language (e.g., English) is used in the same ways - means the same things - in mental health, college, legal, social, business, religious, K-12 educational, healthcare and other myriad settings where interpreters work is untrue. We believe that the restrictive focus on source and target language and generalist practice that characterizes ITP curricula and pedagogy insufficiently prepares interpreters to work in specialty settings such as mental health.

Our research suggests that ITP graduates indeed contend with serious gaps in their preparedness for employment. Working interpreters estimate that two-thirds of the skills necessary to function on the job are acquired after graduation through unsupervised, on-the-job, trial-and-error learning (Dean & Pollard, 2001). This same study indicated that working interpreters do not associate longer periods of ITP training with increased confidence regarding their preparedness for work. Working interpreters report that they experience high rates of stress-related injury and burnout. We believe that these problems, and the negative consequences they portend for the quality of interpreting practice and consumer outcomes, can be addressed with a new approach to the preparation of interpreters, beginning in the ITPs but also in how interpreters are trained at the practica, internship and continuing education level.

Roy (1993) notes that ITPs tend to focus on the "superficial aspects of the communication event which reinforces the notion that the interpreter's task is largely mechanical and that the interpreter's role in the event is passive" (p. 146). ITP practica offerings are particularly limited, both in time and variety. While the Conference of Interpreter Trainers (CIT, 1995) acknowledges the importance of field placements, no set number of practica hours are recommended. Most interpreting students complete practica requirements in two semesters or less, often in K-12 educational settings where the regular presence of deaf students makes arranging placements easier. Most interpreters' first exposure to challenging community work environments such as healthcare, legal, and mental health settings occurs after ITP graduation, when they work in isolation - unsupervised and unable to turn to interpreter colleagues for feedback on their performance.

Despite the above problems, it is widely assumed that services from a certified interpreter provide deaf patients with equal access to mental health services. Apart from the training problems described above, even the term "access" is not the straightforward concept many seem to suggest or believe. The presence of an interpreter may advance "entry" into care but is their presence truly resulting in "access" to the therapist's interventions, to the therapeutic relationship, to the consumer's and the therapist's cognitive and emotional worlds, and most importantly, to equitable treatment outcomes? These and other questions belie common presumptions that the mere presence of an interpreter results in this level of "access" or that certification from the Registry of Interpreters for the Deaf (RID) or the National Association of the Deaf (NAD) "guarantees" this level of access, or that studies of signing vs. non-signing clinicians should proceed before more fundamental research has been conducted on what constitutes optimal sign language interpreting in the mental health field.

While interpreters are certainly a "front door" to access, they also are a complex "variable" in terms of these deeper meanings of access and equity in mental health care. To that end, and based upon our record of research and training excellence in interpreter training and mental health interpreting in particular, we choose to address the first topic proposed in the NIDRR document through the application and analysis of an innovative approach to mental health interpreter training - employing Dean and Pollard's (2001) demand-control (D-C) schema for interpreting work through a unique program of mentored observation-supervision training in several locations throughout the US, followed by the periodic tracking of a range of post-treatment outcome measures. Details of the proposed training and research are provided in the Plan of Operation portion of this narrative. The goal of our interpreter training project is to refine and evaluate the impact of an innovative training approach that will enhance the work effectiveness of interpreters who work in mental health settings, thereby fostering more equitable outcomes in mental health care for deaf and deaf-blind consumers.

The Interpreter Training Project
The goal of the interpreter training project is to refine and evaluate the impact of an innovative training approach that will enhance the work effectiveness of mental health interpreters, thereby fostering more equitable outcomes in mental health care for deaf and deaf-blind consumers. An Objective Structured Clinical Exam (OSCE), a contextualized means of evaluating the performance and judgment skills of practice professionals, will also be refined and produced. The project will be led by co-investigator and project coordinator, Robyn Dean, C.I./C.T. The project methodology will be grounded in Dean and Pollard's (2001) demand-control (D-C) schema for interpreting work and will incorporate the experience of the nations' leading experts in the mental health interpreting field.

Our training program and OSCE development will spring from the successful methods already developed through our project Reforming Interpreter Education: A Practice-Profession Approach (Pollard & Dean, 2001), sponsored by the US Department of Education's Fund for the Improvement of Post-Secondary Education (FIPSE) and conducted in collaboration with the University of Tennessee (see sunsite.utk.edu/cod/fipsedc). That project first immerses students in the D-C schema for interpreting work (Dean & Pollard, 2001). Subsequently, in courses on medical interpreting, post-secondary interpreting, and field work supervision, students engage in a process of D-C-based observations and supervision that is proving highly effective in accelerating student learning about translation and behavioral decisions - comparable to interpreters who have honed their skills over years of professional practice (Davis & Griffin, 2002; Dean, Davis, Dostal-Barnett, Graham, Hammond & Hinchey, in press).

In our FIPSE project, interpreter trainees first learn the D-C schema and then apply it through in-vivo observation activities in practice settings where there is no deaf consumer or interpreter present , including a variety of medical settings and post-secondary educational environments. Unencumbered by interpreting responsibilities or blinded by a singular focus on sign vocabulary, this observation approach fosters student's understanding of interpreting work factors that lie outside the strict bounds of language and culture. Often, it is these non-language, non-cultural factors that most influence translation and ethical decisions.

These additional factors exist in every interpreting work setting; they are what Dean and Pollard (2001) refer to as demands (in accordance with Karasek's (1979) demand-control theory of occupational health and work effectiveness) . In order for interpreters to be effective in their work, the entire spectrum of assignment demands must be understood. Dean and Pollard identify four demand categories in interpreting work: environmental, interpersonal, paralinguistic, and intrapersonal demands. They also identify three opportunities to respond to work demands ² before, during, and after the assignment ² whether those responses include skills development, assignment preparation, specific translation decisions, attitude responses, or behavioral actions.

In our FIPSE project, students bring D-C-structured observation notes into 1:1 supervision sessions with experienced interpreter mentors. Group supervision (i.e., mentor-guided peer supervision) is also employed. In supervision, the language and cultural factors that were purposefully "removed" from the observation experiences are brought forward and interwoven with the environmental, interpersonal, paralinguistic, and intrapersonal demands the student has recorded, through discussions of hypothetical deaf or deafblind consumers who might have been in that situation. Discussions of interpreting for consumers are thus embedded in the students' more thorough appreciation of the nature of the observed work settings and the typical goals and processes of hearing consumer dialogues and interactions in those settings. This fosters a greater comprehension of communication (and service) equity when considering the presence of deaf, hard-of-hearing, or deafblind consumers in such settings. It also allows considerations of multiple, alternative translation and behavioral decision with various types of consumers, which leads to broader, more generalizable learning. This contextualized approach to interpreter training is consistent with contemporary training methods in other practice professions, such as problem-based learning (PBL) in medical education (Frost, 1996.)

There are other benefits to this observation/supervision training approach. In our FIPSE project, students are developing comfort and enhanced professional and consumer respect in the presence of discussions of patients' personal medical histories and physical examinations and procedures. They also are privy to the unique perspectives, communication goals, frustrations, practice challenges, ethical dilemmas, etc., of physicians. These insights foster the interpreters' experience of themselves as fellow practice professionals. And through their application of the D-C schema to interpreting work, they see how their translation and behavioral decisions ² like physicians' decisions ² are responses to complex demands of the job and, in turn, have a complex spectrum of consequences. Through the supervisory process, their dialogues with mentors and colleagues help them to assess, learn from, and refine those decisions ² again, just like all practice professionals do (Dean, et al., in press).

The proposed interpreter training project will begin with a meeting in Rochester, NY where four national experts will join Ms. Dean and Dr. Pollard to discuss and refine the proposed training methods, content, and research plan. Of the experts under consideration, most have already taken D-C schema workshops from Dean and Pollard and have begun incorporating its philosophies and methods in their interpreting work and teaching. After the panel's consensus opinions have been incorporated into the research plan, the training project will be conducted in four urban settings with sizable deaf populations as well as significant ethnic and language diversity within the local deaf population: Rochester, NY (year 1), Minneapolis (year 1), New York City (year 2) and San Francisco (year 2). An expert interpreter mentor in each collaborating city has agreed to participate in the project: Mark Allan English in Minneapolis, Dan Veltri in San Francisco, and Jody Gill in New York City.

In each location, the project will span 5 months. Phase one involves D-C training for the expert mentor and any local collaborators, provided by Ms. Dean. This training will ensure that the collaborators have a thorough understanding of the schema and how it is specifically applied to the observation and supervision components of the trainees' experience. Phase two involves the recruiting and training of a pool of 10 certified interpreters per site (see details below). Phase three involves the administration of an OSCE (described below), designed by the project team and adapted to the local circumstances of the prior training, to the 10 interpreter participants and a sample of 10 local interpreters who did not receive the D-C schema training. Subsequently and for the remainder of the project period, we will be tracking a number of post-training measures (see below).

The method of interpreter training used will parallel the observation/supervision approach described above and successfully employed during our FIPSE project. In this case, however, the observation environments will be a variety of mental health service settings. Only interpreters certified at the C.I./C.T. or C.S.C. levels by the RID or levels 3 ²5 by the NAD will be enrolled in the study. In each participating city, the expert mentors named above will be responsible for arranging site observations for their participants, utilizing their local contacts and resources. Each interpreter participant will complete 30 hours of observations over the course of 4 months in a variety of settings (inpatient, outpatient, emergency department, chemical dependency groups, etc.). To aid in their observation work, participants will use D-C observation sheets (modeled after those being used in our FIPSE project) that help them identify the salient issues in each situation and prepare for their later supervision sessions.

These interactions with mental health professionals in their work environment and "behind the scenes" - including the dialogues that will invariably occur between "patient events" - will yield important learning and professional development benefits for these interpreters, judging from similar results emerging from our FIPSE project. The interpreters will gain a much greater appreciation for the goals, thought processes, and treatment challenges that clinicians face. They will develop, and reflect back to the clinician, a greater appreciation for their own role as a fellow practice professional seeking a similar, collaborative goal of optimal patient care. These relationship benefits are fostered because the observing interpreter is not "in role" or consumed with a singular focus on language and sign choices and because the clinician, in this case, is not a consumer of interpreting services but a fellow practice professional.

While accruing these 30 hours of observations, participants will attend 2-hour group supervision sessions each week, led by the local expert mentor and attended by the other participants in the research cohort. Participants will receive continuing education units from the RID's Certification Maintenance Program. Each of the expert mentors have been involved in mental health interpreter training on a national level. The content of these 2-hour supervision discussions will be driven by the events and issues described on the students' D-C observation sheets but also informed and guided by the expert mentor's own knowledge, pedagogical priorities in mental health interpreting, and teaching style. This approach is more effective than a proscriptive curriculum that a teacher is forced to adhere to and teach in a vacuum. As in PBL, our approach allows the contextualized nature of the problems confronted by the students (their identification of work demands in the four categories defined by Dean and Pollard) and the ensuing discussion of the hypothetical presence of deaf, hard-of-hearing, and deafblind consumers, to draw upon the mentor's (and student peers') knowledge and experiential resources in ways that non-contextualized, rote learning is unable to do effectively (including the typical mental health interpreting training modality of lectures or workshops.) The content that these expert mentors' have previously discussed in lectures, workshops, and publications (e.g., Stansfield & Veltri, 1987; Veltri, 1993, 1997) is quite consistent with one another's (and with Pollard, 1998b) and the collaborative meeting that takes place at the beginning of this project, and the continued oversight of the training by Ms. Dean, will assure that there is agreement and consistency regarding the major content themes, facts, and issues that we desire to impart over the course of the training period. Supplemented by some required readings, the supervision dialogues will be the primary vehicle through which content information is shared. This will not only contextualize the content, leading to better learning and retention, it will allow for the frequent reinforcing of content and promote generalization of learning as students encounter, identify, and discuss similar mental health issues repeatedly over the course of these 4 months.

Our practice profession approach to interpreter training seeks to enhance translation and behavior judgment, confidence, problem-solving skills, and self-evaluation abilities which cannot readily be assessed with existing language-focused interpreter evaluation tools. Fortunately, improvement in methods for assessing these more elusive but critical professional competencies have paralleled the evolution of PBL in medical schools. Among the more widely used approaches is the OSCE. OSCEs commonly involve simulated practice scenarios where students are evaluated on various performance skills (not just knowledge), including professional reasoning and behavior, which is gleaned from post-encounter interviews with students and trained OSCE actor-participants (Educating Future Physicians for Ontario, 1995). An interpreting-specific OSCE is being developed and piloted as part of our FIPSE project (Pollard & Dean, 2001). It is being designed in collaboration with our URMC faculty colleagues who have considerable experience in this evaluation method. Our OSCE will reflect the broader view of critical interpreter competencies we desire to impart through our D-C approach to interpreter training. Our OSCE is intended to set a precedent for the evaluation of interpreter competencies from a practice-profession perspective. This tool and approach should be of interest to ITPs as well as to states that are pursuing licensing regulations and any entity that employs sign language interpreters and seeks to document their competencies. A joint task force of RID and NAD is currently working toward development of a national interpreter examination to replace the current RID test. Leaders of this task force are in close contact with the DWC, monitoring our progress with the OSCE and our other innovations in interpreter training.

The proposed project will develop and employ an OSCE at each of the four sites conducting our D-C training. Local variations in the OSCE scenarios and content will be based on each locale's characteristics in terms of deaf consumers, mental health services available, and the training emphases that emerged over the 4 month training period. The OSCE will consist of practice scenarios that are depicted "live" by teachers and volunteers, on paper, and/or on videotape. Student performance is assessed through eliciting not only specific translation decisions but behavioral decisions (or lack thereof) and the reasoning behind them. Reasoning and actions relating to Dean & Pollard's (2001) four demand categories and three opportunities to employ controls (pre-assignment, assignment, and post-assignment) also will be evaluated. The opinions of the aforementioned expert panel and the local expert interpreter mentors will determine the nature and range of optimal OSCE responses and scores. Again, a control group consisting of 10 similarly certified interpreters who were not part of the training cohort also will take the OSCE at each training site. (They will receive compensation for their time.) Clinical Research Coordinator and interpreter Susan Chapel will score all OSCEs. She will be unaware of the D-C training status of the participants.

Additional post-training measures will be obtained at 6-month intervals throughout the remainder of the project period. These measures will track the impact of the training on the actual work experiences of the trained interpreter cohort from each of the four training sites. These data will include the interpreters' assessments of their work competencies, their frequency of use of D-C concepts and practices in their work, their ongoing assessment of the value of the specialized training they received, and the frequency of their work in various mental health service settings. Also, post-training data will be sought from the hearing and deaf consumers for whom these interpreters work (via a request to participate in the feedback portion of the study that is written on a card the interpreter leaves with consumers; the card will direct consumers to a portion of the study website, where further information can be obtained and feedback questions answered on-line). Consumers will be asked to evaluate various aspects of the quality of the interpreters' services and behavior as well as the impact that the interpreter's services had on mental health service access and outcomes for the consumers. Consumers will be asked to complete the Client Satisfaction Questionnaire Mental Health Center (Larson, et al., 1979). These data will be collected and organized via the web-based data analysis application and report interface that will be used for all studies in this project (described in the Plan of Evaluation section of this narrative).

In year 3 of the project, the accumulated data (and experience) from conducting the interpreter training and administering the OSCEs at these four training sites, and tracking interpreter service outcomes subsequent to each site's training, will be compiled and used to construct a final OSCE and a mental health interpreter training manual for national dissemination. For the final OSCE, we will hire deaf, hard-of-hearing, deafblind, and hearing individuals, including those from ethnic and language minority groups, to portray the most useful mental health service scenarios that emerged from conducting OSCEs at the four training sites. These scenarios will be digitally filmed by URMC audio-visual professionals. Other studies in this NIDRR project also employ digital filming to record actual mental health service delivery to deaf, hard-of-hearing, and deafblind individuals. These acted and actual film clips will be professionally edited and used to produce the final OSCE and training manual which will include relevant film clips and narration on CD (with open captions). The training manual and OSCE package will be completed in year 3 of this project, though data-tracking of our interpreter cohorts will continue through years 4 and 5.