The Third National Conference on
Quality Health Care for Culturally Diverse Populations:
Advancing Effective Health Care through Systems Development, Data, and Measurement

October 2 - 4, 2002, Chicago, IL
Westin Chicago River North Hotel

Session A-1: Using technology to reduce language barriers

Innovative Approaches to Meeting the Requirements for Language Assistance: Remote Simultaneous Medical Interpreting (RSMI)

To dramatically improve on current practices, the Center for Immigrant Health (CIH) and the NYC Health and Hospitals Corporation (HHC), Gouverneur Diagnostic and Treatment Center, implemented a Remote Simultaneous Medical Interpreting (RSMI) system in March of 1999. RSMI uses highly trained simultaneous medical interpreters who interpret through wireless headsets to approximate a same-language encounter–the conduit model. The interpreters are screened for bilingual aptitude and interpreting skill and undergo a rigorous training in simultaneous interpreting. The only existing study of remote simultaneous interpreting in the medical setting was conducted at the Santa Clara Valley Medical Center of Northern California (Hornberger J, 1996). The limited Santa Clara study showed that remote simultaneous interpreting was preferred by both doctors and patients, that it increased accuracy, and that it produced an increase in the exchange of information (as measured through "physician utterances" and "mother utterances"), without extending visit time.

Nevertheless, current knowledge on medical interpreting is empirical. There is controversy regarding the suitability of the different modes of interpreting used in the medical setting: consecutive versus simultaneous, remote versus proximal, and the role of the medical interpreter vis-a-vis cultural brokering. To this end, the CIH is currently conducting research to study the effectiveness and efficiency of these modes of medical interpreting. Analyses are being conducted on medical outcomes, linguistic errors, and cost effectiveness.

This dynamic workshop will provide: a) a comprehensive overview of the Remote Simultaneous Medical Interpreting Model, featuring all its components (screening, training, quality control, continuing education, technology, and costs), and b) practical exposure to the concept by involving participants in role-play scenarios to demonstrate, and provide solutions to, real interactions reflective of multicultural medical settings (including mental health), in which the use of medical interpreters is indispensable to facilitating communication between providers and patients with limited English proficiency. There will also be a discussion of the ongoing research. Didactic and small group teaching methodologies will be utilized, including role-plays, clinical vignettes, and group discussions. The target audience includes hospital administrators, practitioners, policy makers and community members.

Topics to be covered:

1. Overview of the concept of remote simultaneous medical interpreting;
2. Overview of the award-winning, nationally recognized TEMIS Project at Gouverneur Diagnostic and Treatment Center;
3. Overview of the screening procedure developed by CIH to assess prospective simultaneous interpreters’ bilingual aptitude and predict simultaneous interpreting performance;
4. Overview of the curriculum developed by CIH to train prospective individuals in remote simultaneous interpreting;
5. Overview of the quality control program developed by CIH to monitor interpreters’ performance;
6. Overview of the continuing education program developed by CIH to enhance the interpreters’ knowledge base;
7. Role-plays illustrating the ‘conduit’ model: the interpreter as a sole facilitator of the linguistic message;
8. Role-plays illustrating the ‘advocate’ model: the interpreter as a facilitator of the linguistic message and cultural brokering;
9. CIH’s ongoing research in the areas of medical outcomes, cost effectiveness, and linguistic error analysis.

The Center for Immigrant Health is a network of over 1000 community members, social scientists, and health care and public health professionals working with the diverse immigrant groups in New York and nationally. The mission of the Center is to improve access to, and quality of, health care for New York’s large immigrant populations. The Center accomplishes its mission through research, education, information dissemination, and program and policy development.

Javier González, Director
Language Initiatives, Center for Immigrant Health, Division of Primary Care, NYU School of Medicine
550 First Avenue, New York, NY 10016
P 212-263-8242, F 212-263-8234, E jgonz67@cs.com, http://www.med.nyu.edu/cih

The Director of Language Initiatives at the Center for Immigrant Health, Javier has worked to implement the Remote Simultaneous Medical Interpretation (RSMI) project, has developed a simultaneous medical interpretation training curriculum and quality control program, and has developed the Center's translation curriculum and service. He accomplished this through his direct experience at Gouverneur Diagnostic and Treatment Center where he is director of operations and instruction of the remote simultaneous medical interpreting program and where he has learned of the great need for better written materials in languages other than English. Furthermore, recognizing the need for better translation services, Javier created the translation service program at CIH, which is now equipped with a pool of qualified translators in more than 15 languages and who adhere to the Center’s translation principles. Javier is also the coordinator and instructor of the translation and interpreting program at Hunter College's Continuing Education Department. He has also worked as head translator, writer, and editor of the Spanish section of the New York Online Access to Health, a health educational website of CUNY. Javier has a BA in Anthropology with a focus on linguistics from George Washington University.

Francesca Gany, MD, MS, Director
Center for Immigrant Health, Division of Primary Care
NYU School of Medicine, 550 First Avenue, New York, NY 10016
P 212-263-8897, F 212-263-8234, E fg12@nyu.edu, http://www.med.nyu.edu/cih

As the founder and director of the Center for Immigrant Health, and a member of the faculty of the New York University School of Medicine, Dr. Gany has extensive background in immigrant health research, curriculum development, education, and program and policy development. Dr. Gany teaches primary care, immigrant health, and health policy and medical economics at the School. She has published and lectured widely on immigrant health issues and has facilitated the dissemination of model projects nationally. Dr. Gany holds a B.S. in Biology from Yale University, an MD from Mt. Sinai School of Medicine, and an MS in Health Policy from the Wagner Graduate School of Public Service

Jyotsna Changrani, MD, MPH, Assistant Director
Center for Immigrant Health, Division of Primary Care
NYU School of Medicine, 550 First Avenue, New York, NY 10016
P 212-263-8242, F 212-263-8234, E jchangra@yahoo.com, http://www.med.nyu.edu/cih

Jyotsna Changrani serves as the Assistant Director for the Center for Immigrant Health, where she fulfills various roles, including conducting research, education, and training. Dr. Changrani has been actively involved in the Center’s cultural competence initiatives, including research into current and best practices on culturally competent health care delivery, knowledge-garnering efforts on cultural beliefs and practices and their impact on health-seeking behavior and decision-making, development of a comprehensive cultural competence curriculum, and cultural competence trainings for health care and other institutions. Dr. Changrani has also worked to develop and implement various curricula at New York University School of Medicine, including a Cultural Competence Curriculum at the Center for Immigrant Health, and a curriculum in Global Health. Dr. Changrani has developed a program that emphasizes the use of information technology to enable creative public health applications, including Bridging the Language Gap, a web-based learning module for health care practitioners on cross-cultural health care and working with interpreters, and the Virtual Community for Immigrants with Cancer, a two-year pilot project developed to advance immigrants’ ability to cope with cancer and increase their confidence in accessing treatment options. Dr. Changrani is the Principal Investigator for an NIH/NCI-funded project to develop culturally appropriate cancer information websites for immigrants. Dr. Changrani completed her medical training in India, where she worked extensively in community outreach and education projects, and received her M.P.H. from the Harvard School of Public Health.

Stefanie Trice, Project Coordinator
Language Initiatives, Center for Immigrant Health, Division of Primary Care
NYU School of Medicine, 550 First Avenue, New York, NY 10016
P 212-263-8242, F 212-263-8234, E trices01@med.nyu.edu, http://www.med.nyu.edu/cih

As the Project Coordinator of Language Initiatives at the Center for Immigrant Health, Ms. Trice has been working with Mr. Gonzalez as a co-trainer and also coordinates the Center's translation work. Prior to joining the Center for Immigrant Health, Ms. Trice worked for over 8 years within the Chinese, Latino, Brazilian, and Haitian communities as a bilingual advocate, interpreter, and editor in the context of the arts, medical care, and community organizing. Ms. Trice has a Bachelor of Arts degree in East Asian Studies/Chinese from Wesleyan University in Connecticut and speaks English, French, Mandarin Chinese, Portuguese, and Spanish fluently.

Strong Connections: A Videoconference Medical Interpreting Service

Strong Connections uses leading-edge videoconference technology to bring medically-experienced sign language interpreters "into the room" at remote healthcare settings where deaf patients or family members have presented. Our goal is to enhance healthcare access for deaf people and their families by providing expert interpreter services to healthcare institutions that have limited or no access to local interpreters. Strong Connections has been serving patients in the Olean and Buffalo, NY regions since August, 2000. To date, approximately 50 patient services have been rendered and Strong Connections has grown to the point that we have begun inviting hospitals and other healthcare facilities around the country to subscribe to our service. Strong Connections won the 2001 Health Care Advocacy Award from the Healthcare Trustees of New York State.

The service works in this manner. Two-way audio and visual communications are established between our office in Rochester, NY and the remote service location, using two videoconference units connected by three "bundled" ISDN lines, and a camera and microphone at each end. The three ISDN lines yield a 384 kbs data transfer rate — the minimum necessary for clear, bi-directional sign language communication, according to our tests. The Strong Connections interpreter observes the deaf patient’s sign language through the remote camera and translates into spoken English for the healthcare provider to hear through the monitor’s speakers. The provider simply speaks to the patient, who watches the signed translation by viewing the monitor.

Strong Connections has been six years in development. Technical trials, fundraising, and "beta testing" phases have brought us to our current state of readiness for national dissemination. We have sought and obtained critical support from our home institution and from foundations and local business consultants. Strong Connections has attracted more than $500,000 in funding from a variety of groups interested in healthcare and the deaf population. Many tasks had to be accomplished once the service proved technically feasible and our test sites were satisfied with our service quality. The administrative, staffing, and daily operational structure of the service had to be planned in detail. A feasible and competitive pricing structure had to be determined in light of accurate service and growth projections and existing fiscal and personnel resources. High quality educational and presentation materials describing our service, and the need and legal mandate for deaf population access to interpreter services in healthcare, had to be developed. The Strong Connections service site had to be outfitted with the proper equipment. Our interpreter staff had to be trained in readiness for our national rollout.

With all these program arrangements now in place, the Strong Connections team is primarily focused on solidifying service relationships with healthcare facilities around the country. This, however, is a difficult task, given the degree of education that most healthcare facility decision-makers need in order to appreciate the importance and legal mandates pertaining to interpreter services for deaf consumers and the need to overcome resistance to expending tight hospital resources on interpreter services. This has led to our recognition that our brochures, website, and conference presentations will not overcome these knowledge and attitude barriers quickly enough for Strong Connections to attain fiscal self-sufficiency as rapidly as we need to. A more direct approach is being developed and implemented, to supplement our existing education/dissemination plans. The Strong Connections representatives at this conference will be happy to discuss our experiences, successes, and challenges with the audience members.

Robert Pollard, PhD is director of URMC’s Deaf Wellness Center and the Strong Connections program. The Deaf Wellness Center is home to a number of service, educational, and research initiatives pertaining to deaf people, mental health, healthcare, and interpreting. Kathy Miraglia, MS, CSC, is coordinator of interpreting services at URMC and manager of the Strong Connections service. She has over 25 years experience in the deafness field.

Strong Connections
University of Rochester Medical Center
601 Elmwood Avenue, Box 602, Rochester, NY 14642
Phone: 585-275-9200
Fax: 585-244-8483
E-mail: StrongConnections@urmc.Rochester.edu
Web: http://www.urmc.Rochester.edu/StrongConnections

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