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Meeting the Needs of Deaf Patients: The Provider's Responsibility and How Technology Can Help

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Meeting the Needs of Deaf Patients – The Provider’s Responsibility and How Technology Can Help

Presented by Jaclyn Evans & Debbie Lesser Sponsored by InDemand Interpreting

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UNDERSTANDING THE ADA REQUIREMENTS FOR THE DEAF COMMUNITY AND HOW TO MEET THEIR NEEDS.

+ OBJECTIVE

Sponsored by InDemand Interpreting

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Debbie Lesser CI, CT Jaclyn Evans

SPEAKERS

INOVA HEALTH SYSTEM Sign Language Services Manager INDEMAND INTERPRETING Director of ASL Services & Medical Interpreter

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Debbie has been a nationally certified sign language interpreter since 1999. She holds a degree in Psychology with a focus in crisis intervention. With a background in call center operations and management, Debbie has served as the Operations Manager for two different VRS companies and has managed over 160 interpreters.

INTRODUCING

B i o

Debbie Lesser, CI, CT

INDEMAND INTERPRETING Director of ASL Services & Medical Interpreter

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INDEMAND INTERPRETING

American Sign Language Interpreting & Cultural Aspects

• f the Deaf Community

Sponsored by InDemand Interpreting

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The Deaf Patient Experience Diversity Among the Deaf Population Lip Reading ASL Interpreting Provider Responsibilities

Outline

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Deaf Patient Experience

AMERICAN SIGN LANGUAGE INTERPRETING & CULTURAL ASPECTS OF THE DEAF COMMUNITY

• Limited FOI*— Unlike other cultural

minorities – hearing loss encompasses them all

• 90% of deaf children are born to hearing families

who don’t know sign language

• 10% are Deaf of Deaf

–Cultural vs. Pathological views

*Freedom of Information

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Deaf Patient Experience

AMERICAN SIGN LANGUAGE INTERPRETING & CULTURAL ASPECTS OF THE DEAF COMMUNITY

• Excluded from family healthcare talk including

family illness & history

• Limited healthcare education at home or

in school

• Literacy barriers
• Healthcare is done to me (role passivity)
• Lack of trust in hearing people who make decisions

for/about them

• Interpreters are seen as linguistic allies and

Cultural Mediators

Sponsored by InDemand Interpreting

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National Certifications

• RID
• CDI / Trilingual
• State Licenses
• Medical experience
• Linguistic expert on medical team

Speak Normally

• ASL is ‘heard’ with the eyes. The brain connection with the

ears remains functional. ASL can be watched at the same time as any verbal language is listened to, which is a complex mental process.

ASL INTERPRETING

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Accessibility ISN’T a luxury – it’s a MANDATE 70% of MALPRACTICE actions are due to relationship and COMMUNICATION ISSUES between provider & patient

Provider Responsibilities

AMERICAN SIGN LANGUAGE INTERPRETING & CULTURAL ASPECTS OF THE DEAF COMMUNITY

Legal Obligations–Effective Communication

Sponsored by InDemand Interpreting

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Benefits of using an InDemand Interpreter:

No waiting Immediate access No late or cancelled appointments Top of the line technology

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Information for Deaf Patients

*DO I HAVE THE RIGHT TO AN ONSITE INTERPRETER?

If the InDemand interpreter and system is not providing you with proper accessibility, you have a right to accessible

• communication. Please

let your provider know if you have issues or concerns.

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Jaclyn has worked in the field of Sign Language Services for close to 18 years. She currently manages all aspects of the Sign Language Services Department at Inova Health Systems which includes: 14 PRN ASL Interpreters, 5 Sign Language Schedulers, Agency Relationships and Video Remote Interpreting vendor relationships. She oversees all services provided to all Deaf and or hard of hearing patients and their companions. In addition, Jaclyn provides training to all Inova staff regarding policies and procedures around “effective communication”, and is part of the team that is responsible for writing all policies and procedures around deaf and hard of hearing patients and or their companions.

INTRODUCING

B i o

Jaclyn Evans

INOVA HEALTH SYSTEM Sign Language Services Manager

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UNDERSTANDING THE LEP CHALLENGE, WHERE IT STANDS AND HOW IT WILL GROW

LEP: Limited English Proficiency

+ OBJECTIVES

Sponsored by InDemand Interpreting

ADA LEGAL REQUIREMENTS

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ABOUT

5 Hospitals 5 Stand Alone Emergency

Care Centers

6 Urgent Care Centers 20 Primary Care Centers

Numerous Adult and Pediatric Specialties

Inova Health System

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ADA TITLE III

ADA LEGAL REQUIREMENTS

Sponsored by InDemand Interpreting

“The ADA requires that title II entities (State and local governments) and title III entities (businesses and nonprofit organizations that serve the public) communicate effectively with people who have communication disabilities. The goal is to ensure that communication with people with these disabilities is equally effective as communication with people without disabilities.”

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ADA:

EFFECTIVE COMMUNICATION

“For people who are deaf, have hearing loss,

• r are deaf-blind, this

includes providing a qualified note taker; a qualified sign language interpreter, oral interpreter, cued-speech interpreter, or tactile interpreter; real-time captioning; written materials; or a printed script of a stock speech.”

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“Qualified” Interpreter?

ADA LEGAL REQUIREMENTS / EFFECTIVE COMMUNICATION

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A “qualified” interpreter means someone who is able to interpret effectively, accurately, and impartially, both receptively (i.e., understanding what the person with the disability is saying) and expressively (i.e., having the skill needed to convey information back to that person) using any necessary specialized vocabulary.”

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What is VRI?

ADA LEGAL REQUIREMENTS / EFFECTIVE COMMUNICATION / VRI

“Video remote interpreting (VRI) is a fee-based service that uses video conferencing technology to access an off-site interpreter to provide real-time sign language

• r oral interpreting services for

conversations between hearing people and people who are deaf

• r have hearing loss.

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CHOOSING TO USE VRI

ADA LEGAL REQUIREMENTS / EFFECTIVE COMMUNICATION / VRI

The new regulations give covered entities the choice of using VRI or on-site interpreters in situations where either would be

• effective. VRI can be especially useful in rural areas where on-

site interpreters may be difficult to obtain. Additionally, there may be some cost advantages in using VRI in certain circumstances. However, VRI will not be effective in all circumstances…

Sponsored by InDemand Interpreting

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For Example:

It will not be effective if the person who needs the interpreter has difficulty seeing the screen (either because of vision loss or because he or she cannot be properly positioned to see the screen, because of an injury or other condition). In these circumstances, an on-site interpreter may be required.

ADA LEGAL REQUIREMENTS / EFFECTIVE COMMUNICATION / VRI

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ADA LEGAL REQUIREMENTS / EFFECTIVE COMMUNICATION / VRI

If VRI is chosen, all of the following specific performance standards must be met:

Real-time, full-motion video and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication; A sharply delineated image that is large enough to display the interpreter’s face, arms, hands, and fingers, and the face, arms, hands, and fingers of the person using sign language, regardless of his or her body position; A clear, audible transmission of voices; and, Adequate staff training to ensure quick set-up and proper operation.

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We closely monitor the DOJ (Department of Justice) website www.ada.gov. Monitoring the actions of the DOJ lends itself to offering a more pragmatic approach to the challenge of providing “effective communication”. The details of consent decree documents are available on line, and provide a great resource for businesses to tailor their services after to avoid ending up in litigation.

ADA LEGAL REQUIREMENTS / LITIGATION

The Consents Decree’s

Sponsored by InDemand Interpreting

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INOVA’S COMPREHENSIVE SOLUTION FOR LANGUAGE SERVICES

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We demonstrate this in our interpreter services by asking each and every patient and their companion if they communicate in English or/if they use another language to communicate.

INOVA FIRMLY SUPPORTS PATIENT- CENTERED CARE.

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If they desire a Sign Language Interpreter we let each individual patient or companion help make the decision if we will provide “on site” interpreters or VRI, but most frequently it is a combination of both.

INOVA’S INTERPRETIVE SERVICES

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Inova’s History with Interpreter Services

INOVA’S COMPREHENSIVE SOLUTION FOR LANGUAGE SERVICES

Sponsored by InDemand Interpreting

2011- Inova only utilized vendors, agencies and VRI for their Interpreter needs (most expensive option) 2012- Inova made the decision to hire their own Interpreters and make them Inova employees (most efficient option, but the alienation of the agencies led to lack of interpreters when most needed, creating a legal and safety risk) 2014- Inova added InDemand VRI, decreased the number of internal employee Interpreters, and added a contract with an agency for a set number

• f hours per month in exchange for a much lower per hour cost (Inova has

found this is the best approach, maintaining some level of “competition” is needed to ensure interpreter availability balanced with cost efficiency)

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• Inova currently has a staff of 14

PRN American Sign Language Interpreters.

• Inova additionally contracts with

3 local Interpreting Agencies.

• Inova has a Sign Language

Scheduler on duty 24/7 (for staff at any of our locations to request an interpreter).

Inova’s Innovative Solution

INOVA’S INTERPRETIVE SERVICES

Inova offers VRI (via InDemand) at all of

• ur hospitals

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INOVA’S CHALLENGES & SOLUTIONS

CHALLENGES Providing “on site” interpreters in a timely manner Meeting the needs of numerous system wide requests simultaneously

INOVA’S SOLUTION FOR LANGUAGE SERVICES

SOLUTIONS Inova hired ASL Interpreters as internal employees. We are able to have “on call” interpreters to meet our off hour or emergent situations. By having contracts with local Interpreting Agencies we have been able to significantly lower the cost per hour in exchange for a minimum number of hours assigned to a specific agency. Expanding VRI to more locations has been imperative.

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INOVA’S COMPREHENSIVE SOLUTION FOR LANGUAGE SERVICES

Sponsored by InDemand Interpreting

• TECHNICAL
• Connectivity or internet instability
• Not suitable for all patients (immobilized, visually impaired,

group therapy sessions, etc.)

• TRAINING
• Staff education or reluctance to utilize the unit

VRI CONSIDERATIONS

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BENEFITS OF USING VIDEO REMOTE INTERPRETING (VRI)

Sponsored by InDemand Interpreting

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HOW HAS VRI HELPED?

• Most cost-effective option (pay by the minute, instead of a 2 hour

minimum for “on site” interpreters)

• Most efficient option, the interpreter is available immediately with no

wait time

• Enables more patients to use simultaneous services
• Infection or exposure control. One of our hospitals is a designated

“Ebola” care location, VRI offers the ability to serve a non-English speaking or deaf patient with no risk of exposure to the interpreter, and is part of our emergency plan.

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• Our mission is “To improve the health
• f the diverse community we serve

through excellence in patient care, education and research.”

• Feel free to visit www.inova.org for

more information. CLOSING

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Q & A

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Thank You.

Sponsored by InDemand Interpreting