Bulletin

2021

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Bulletin vol. 34 no. 1 | 15 harsh artificial light sources. With spoken languages, interpreters may sit next to the clinician or next to or behind the patient ensuring access to their voice. The clinician should check with the patient throughout the evaluation about whether any changes need to be made to the physical environment. For medical procedures involving the neuropsychologist, more flexibility or innovation may be required depending on how many medical staff are in the operating or exam room. For example, step stools or mirrors may need to be available for the patient to access facial or signed cues produced by the interpreter. For additional information, refer to the NCIHC (2003) working paper, The Guide to Interpreter Positioning in Health Care Settings. Interacting with the Patients and Interpreters Professionals should always look at and direct comments to the patient using second rather than third person pronouns. Looking directly at interpreters rather than the patient may disrupt the flow of conversation, impeded the ability of the patient to glean information from the neuropsychologist's face, and may even be considered disrespectful in many cultures. If the neuropsychologist needs to communicate with the interpreter during the evaluation, inform the patient of this interaction and explain the purpose of the side conversations. It may become clear during the work that modifications (e.g., simpler language, shorter sentences, or a slower rate of speech or sign) are required either through observation of the verbal exchanges or via feedback from the interpreter. In such cases, interpreters are trained to manage most of these situations and will ask for any clarifications or modifications. When needing to clarify or repeat information, the neuropsychologist should ask the patient directly, unless the interpreter is providing contextual information. Debriefing Session with Interpreters It is recommended to include at least a 15- to 60-minute debrief period at the end of each appointment to assist with gathering information that may be crucial to the patient's evaluation or treatment plan. As some interpreters are not accustomed to this type of debriefing, it is important to frame this time as an opportunity to clarify the data collected through the interpretation. Debriefing is an optimal opportunity for the interpreter to explain linguistic and cultural factors that may assist with conceptualization or diagnoses. The process can help to clarify a dialect or regionalism used by the patient, differences noted in receptive or expressive abilities, the speed and fluency of the language used, atypical language production, or other questions or concerns noted during the consultation or evaluation. This time also allows for the neuropsychologist to gain clarification regarding observed behaviors or facial expressions that may have carried linguistic or cultural meanings. It is important to note the neuropsychologist will often need to drive these conversations, especially if the interpreter has limited experience with neuropsychological procedures or certain types of medical and behavioral presentations. Special Considerations when Working with Interpreters in Operating Rooms, Intensive Care Units, In-Patient Units, and Isolation Rooms Ensuring inclusion of in-person interpreters in certain medical settings and situations can present a number of challenges. For example, evaluations and interventions can occur at the last minute, occur in on-going or brief interactions, or may require professionals and patients to use personal protective equipment (PPE) that adversely influences communication. During the COVID-19 pandemic, a number of novel issues have arisen for neuropsychologists and in-person interpreters working with multilingual individuals or those with limited English proficiency with regard to the patient's ability to speak or sign if intubated, using nasal oxygen cannulas, facial masks, peripheral or central venous catheters, or other medical equipment that limits movement of the face, lips, arms, or hands. It also is important to consider who is allowed in proximity to a patient, the room layout, and the required PPE for the professional as this may adversely influence effective access to communication. For Deaf, hard of hearing, and Deafblind patients who rely on ASL, thinner gloves that contrast with the skin color of the interpreter can aid in comprehending sign language. The use of protective face shields or FDA-registered clear surgical masks allows the patient to more easily access lip reading, verbal cues conveyed through facial movements, and nonverbal and affective information expressed on the face. Considerations when Documenting Work with Interpreters When completing health records, it is important to document the following either in the report or the electronic health record: 1) language knowledge and skill of the neuropsychologist and the language(s) they used during the session; 2) the type and number of interpreters participating in the session; 3) if the same individuals assisted across multiple sessions; 4) the modality of interpretation and the specific language(s) or communication modality(ies); 5) a clear description of all modifications or accommodations pertaining to test administration; 6) an explanation concerning if the modifications and accommodations possibly influenced the diagnostic process and clinical conceptualization; 7) the interpreter's name, agency, credentials, and interpreter ID (if available); 8) information regarding whether pre-conferencing and debriefing sessions occurred; 9) how the interpreters were integrated in the session; and 10) any unusual events or experiences of the neuropsychologist, interpreter, or patient. Summary This paper attempts to synthesize relevant information needed to orient neuropsychologists to important terminology, ethical and professional considerations, and suggestions for conducting interpreter-mediated assessments and interventions.

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