Bulletin

14 | Bulletin vol. 34 no. 1 for spoken language interpreters may be obtained from the American Translator Association (ATA), the Certification Commission for Healthcare Interpreters (CCHI), and the National Board of Certification for Medical Interpreters (NBCMI). National certifying entities for hearing and deaf sign language interpreters and oral transliterators include the Registry of Interpreters for the Deaf (RID). The certification processes may require additional training, including ethical expectations; however, it is not a requirement for many interpreters. Furthermore, some interpreters do not complete formal interpreter training programs (ITP) or postsecondary degree programs in interpretation. As such, an institution or sole provider should attempt to inquire about and hire a certified and qualified interpreter with knowledge of behavioral and medical health terminology in the specific language of the patient, as well as experience working in neuropsychological settings. Types of Interpreting Services While there are variety of on-demand interpreting services and modalities available to neuropsychologists (e.g., phone-to-phone, video remote interpreting: VRI, point-to-point video relay services: VRS), we recommend in-person interpretation, especially for assessment-based situations. This allows for interpreters to use environmental and extra-linguistic context as part of their process, as well as reducing any technological mishaps resulting from equipment, software or connectivity problems. Obtaining interpretation services via family members is highly discouraged due to ethical concerns as they do not have formal training, may compromise confidentiality, may obscure the nature of the symptoms, and are likely to produce a higher number of errors in interpretation. Further, their familiarity with the patient and their situation may negatively impact the examinee or examiner by intentionally or unintentionally adding, transforming or withhold pertinent information. This experience can also be potentially distressing to the patient and the family member. The use of peers and other professionals in the same setting (e.g., assistants, office personnel, medical staff) who are not qualified interpreters should also be avoided as they lack training in interpretation and may not have the vocabulary needed to serve in this role and can bias results (Strutt, Resendiz, Perry & Burton, 2017). Language Service Providers or Direct Contracts Some institutions provide staff interpreters for ASL or language(s) commonly used in the catchment area. However, a large majority of interpreters may be contracted through direct hire or Interpreter Referral Agencies (also known as Language Service Providers). More prominent institutions may have contracts with one, at times two, interpreting agencies to ensure that the agency coordinates interpreters. On the other hand, smaller clinics or institutions and sole practitioners may need to directly hire interpreters. An interpreting agency may be more beneficial than a freelance interpreter. An agency often implements safeguards to screen the interpreters, determine their experience and level of comfort with neuropsychological work, and prevent missed appointments. The above may not be possible when hiring freelance interpreters especially in geographic locations where there are few professionals or a limited representation of known languages. Two certified and qualified interpreters are often hired for any assignment over two hours, or any complex assignment regardless of length. This practice is particularly true for sign language interpreters and assignments involving trilingual interpretation. A team of interpreters ensures for all messages to be rendered faithfully, prevents cognitive overload, and prevents physical exhaustion of the interpreters. If only one interpreter is present, it is recommended that the neuropsychologist provide a 10-minute break per hour for the interpreter and patient. If multiple sessions are required, it is recommended to book the same interpreters to develop and maintain rapport, facilitate smooth communication, and save time in having to repeat your process and expectations. Pre-Conferencing Session with Interpreters Clinical neuropsychologists coordinate evaluations and services; therefore, interpreters follow their lead in collaborating with the patient. The neuropsychologist should consider including pre-conferencing with the interpreter prior to the first, if not all appointments. This may occur in advance of the scheduled appointment or for 15 to 60-minutes before the first appointment. The pre-conferencing session allows for interpreters to understand the nature of the appointment and allows for neuropsychologists to inquire about what mode of interpretation will be used during portions of the session. Interpreters may use a variety of modes during the appointment. The neuropsychologist should provide the interpreter relevant demographic information obtained on the patient, potential symptoms associated with a syndrome or disorder that might impact the testing, and routine questions asked during a clinical interview. Interpreters will generally ask for and benefit from reviewing the planned test battery or intervention. Despite having an interpreter, neuropsychologists should attempt to obtain appropriately translated and adapted measures shared in the literature or in consultation with a neuropsychologist experienced with testing in the language of the patient. These measures may include adaptations to verbally-mediated tests that account for phonemic length, lexical-cultural frequency, and semantic equivalence of words across languages. Reviewing measures and procedures with interpreters assists them to conceptualize how the instructions and materials should be presented (e.g., register, speed, repetitions) and allows them to become familiar with the content, especially to assist in the interpretation of timed tasks or language tests involving multiple commands, complex language, or verbal memory tasks. If other medical or surgical procedures are to be completed during the appointment (e.g., Wada, deep brain stimulation, and awake craniotomy), interpreters should be informed in advance of the environment where they will interpret and of the related protocols. Pre-planning for these latter procedures is very important given the physical arrangement of the room and professionals, potential time constraints, and potential complications. Arranging the Physical Environment For assessments and interventions occurring in an office setting, the modality of the language and psychological procedures to be completed is heavily influenced by the interpreter's placement. Sign language interpreters should be in an area where the patient can clearly see or hear them and the neuropsychologist, with the interpreter often sitting next to the neuropsychologist; although some patients will request other arrangements based on their need for visual or auditory access or cultural preferences. Adequate lighting also needs to be considered for both the interpreter and the deaf, hard of hearing, low vision, or blind patient to ensure the professionals are not backlit by a window or

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