Barriers to Access in the Norwegian Criminal Justice System

This chapter presents and discusses barriers that Deaf people who have Norwegian Sign Language as their first language face in encounters with the Norwegian criminal justice system. Since this system is based exclusively on spoken language, and mainly depends on the individual law professional’s ability to establish critical, self-reflective practices in each case, Deaf people’s legal safety, as demanded by the rule of law, cannot be taken for granted. Establishing a public, independent, professionalized sign language interpreter service in Norway, however, has helped to reduce risks for Deaf people. Independent interpreters can demand changes in the criminal justice system’s practices, thus making these practices more accessible to Deaf people. Empirical examples illustrating the interaction between Deaf people, law professionals, and interpreters are presented and analyzed. This interaction is less characterized by conflict and more by cooperation and mutual recognition, where both Deaf people and law professionals state their confidence and trust in their interpreters. The chapter concludes that structural change and organization, such as the establishment of an independent public interpreter service in Norway, trump general and well-meant inclusive intentions in organizations such as the Norwegian criminal justice system when it comes to secure Deaf peoples’ rights and the prevention of miscarriage of justice.

“The talking bit of medicine, that’s the most important bit”: doctors and Aboriginal interpreters collaborate to transform culturally competent hospital care

Background In hospitals globally, patient centred communication is difficult to practice, and interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and that interpreter-medicated communication in healthcare is an aberration. In Australia’s Northern Territory at Royal Darwin Hospital, it is estimated around 50% of Aboriginal patients would benefit from an interpreter, yet approximately 17% get access. Recognising this contributes to a culturally unsafe system, Royal Darwin Hospital and the NT Aboriginal Interpreter Service embedded interpreters in a renal team during medical ward rounds for 4 weeks in 2019. This paper explores the attitudinal and behavioural changes that occurred amongst non-Indigenous doctors and Aboriginal language interpreters during the pilot. Methods This pilot was part of a larger Participatory Action Research study examining strategies to achieve culturally safe communication at Royal Darwin Hospital. Two Yolŋu and two Tiwi language interpreters were embedded in a team of renal doctors. Data sources included interviews with doctors, interpreters, and an interpreter trainer; reflective journals by doctors; and researcher field notes. Inductive thematic analysis, guided by critical theory, was conducted. Results Before the pilot, frustrated doctors unable to communicate effectively with Aboriginal language speaking patients acknowledged their personal limitations and criticised hospital systems that prioritized perceived efficiency over interpreter access. During the pilot, knowledge of Aboriginal cultures improved and doctors adapted their work routines including lengthening the duration of bed side consults. Furthermore, attitudes towards culturally safe communication in the hospital changed: doctors recognised the limitations of clinically focussed communication and began prioritising patient needs and interpreters who previously felt unwelcome within the hospital reported feeling valued as skilled professionals. Despite these benefits, resistance to interpreter use remained amongst some members of the multi-disciplinary team. Conclusions Embedding Aboriginal interpreters in a hospital renal team which services predominantly Aboriginal peoples resulted in the delivery of culturally competent care. By working with interpreters, non-Indigenous doctors were prompted to reflect on their attitudes which deepened their critical consciousness resulting in behaviour change. Scale up of learnings from this pilot to broader implementation in the health service is the current focus of ongoing implementation research.

Lack of English proficiency is associated with the characteristics of work- related injury and recovery cost in the Victorian working population

BACKGROUND: Migrant workers have been identified in Europe, North America, Asia and Australia as a particularly vulnerable working population with a higher risk of work-related injury and mortality compared to non-migrant workers. Lack of English language proficiency is associated with an increased risk of work-related injury. Whether lack of English proficiency influences post-injury recovery or return to work outcomes remains unknown. OBJECTIVE: Using administrative data from a population based workers’ compensation dataset in the state of Victoria, Australia, we aimed to examine work-related injury rates, worker characteristics and compensation outcomes in workers who were not proficient in English. We hypothesized that the use of an interpreter service would be associated with a poorer post-injury recovery profile and worse return to work outcomes. METHODS: WorkSafe Victoria accepted non-fatal claims for injuries and illnesses reported between January 1, 2003, and December 31, 2012 by workers aged 15 to 74 (n = 402, 828 claims) were analysed. Consistent with prior research, we selected “use of an interpreter service” as the indicator of English language proficiency. The total and categorical compensable cost of recovery was used as recovery outcomes. RESULTS: Of these claims, 16,286 (4%) involved the use of an interpreter service (LOTE workers). Our analysis revealed that Victorian injured LOTE workers have significantly different demographic, occupational and injury characteristics compared to non-LOTE injured workers. Furthermore, we present novel evidence that LOTE status was associated with poorer long-term injury outcomes, observed as a greater healthcare utilisation and larger paid income benefits, after controlling for occupation, employment status and injury type compared to non-LOTE injured workers. CONCLUSIONS: These data suggest that English language proficiency is associated not only with the risk of work-related injury but also to the long-term recovery outcomes. We conclude that despite access to language interpreter services, injured LOTE workers experience English language proficiency dependent, and injury severity independent, recovery barriers which need to be overcome to improve long term recovery outcomes.

Adapting wellbeing research tools for Aboriginal and Torres Strait Islander people with Chronic Kidney Disease

Background There is an acute need to develop wellbeing measures and interventions that are appropriate for Aboriginal and Torres Strait Islander people, including residents of remote communities who have chronic physical conditions. The Kessler 10, Patient Health Questionnaire 9, and EuroQoL are valid, reliable, and commonly used tools to assess various aspects of wellbeing but have not yet been translated to Aboriginal and Torres Strait Islander languages. Similarly, the Stay Strong App is a brief, culturally responsive, e-mental health intervention, but has not been used with Aboriginal and Torres Strait Islander people with Chronic Kidney Disease. Methods We aimed to pilot test the above tools with Aboriginal and Torres Strait Islander Australians with Chronic Kidney Disease Stage 5 (CKD-5) and develop revised versions suitable for use in a clinical trial using a four-stage multi-method approach. Stage 1: Pilot testing of outcome measures and Stay Strong App intervention in a purposive sample of five haemodialysis patients and carers to examine acceptability. Stage 2: Translation of outcome measures through collaboration between the Aboriginal Interpreter Service, Aboriginal and Torres Strait Islander research officers and research team. Stage 3: Conversion of revised outcome measures to electronic format. Stage 4: Collaboration of research team and an Expert Panel in an iterative approach to adapt the Stay Strong App. Results Stage 1: Pilot testing of outcome measures identified three areas of difficulty: explanation of time frames and frequency responses, translation of the terms ‘worthless’ and ‘hopeless’, and fatigue and boredom related to the assessment process. Stage 2: Translation of most items was uncontroversial. Discrepancies between team member views and local interpretations of specific terms were addressed. Final drafts were forwarded to the Aboriginal Interpreter Service for translation. Stage 3: Audio translations in 11 languages were integrated into an interactive Outcome Measures App. Stage 4: A new renal version of the Stay Strong App was developed through research team and expert panel consensus. Conclusion The four-stage approach allowed adaptation of the tools for use within a future trial of wellbeing interventions for Aboriginal and Torres Strait Islander people receiving haemodialysis. Trial registration: ACTRN12617000249358 Registered 17 February 2017.

Register-based study concerning the problematic situation of using interpreting service in a region in Sweden

Background Due to increasing international migration, Sweden has become a multicultural and multilingual society, with about 19% of the population born abroad, which imposes high demands on the healthcare sector and interpreting services. The aim was to investigate problems in the use of interpreters as recorded by healthcare staff and the interpreter service in a region in Sweden. Methods Cross-sectional register-based study. The study focused on a geographically well-defined region in Sweden including (a) specialized care at three hospitals; (b) local healthcare, including out-patient clinics at hospital and emergency healthcare and primary healthcare; and (c) dental care. The study was based on 726 existing incident reports on the interpreting service and information from the interpreter agency from 2012 and the first quarter of 2016 during a period of a massive influx of refugees. Results The highest number of adverse advents was reported in local healthcare and mainly concerned the absence of an interpreter at the appointed time. Non-authorized in-person interpreters performed most interpretation assignments and Arabic was the most requested language. Conclusions This study highlights the significance of good cooperation between healthcare and the interpreter service in order to guarantee safe and high-quality healthcare for patients in need of interpreters to be able to communicate in healthcare.

Observational study to understand interpreter service use in emergency medicine: why the key may lie outside of the initial provider assessment

ObjectiveTo characterise the use of interpreter services and other strategies used to communicate with limited English proficient (LEP) patients throughout their emergency department visit.MethodsWe performed a process tracing study observing LEP patients throughout their stay in the emergency department. A single observer completed 47 hours of observation of 103 communication episodes between staff and nine patients with LEP documenting the strategy used to communicate (eg, professional interpreter, family member, own language skills) and duration of conversations for each communicative encounter with hospital staff members. Data collection occurred in a single emergency department in the eastern USA between July 2017 and February 2018.ResultsThe most common strategy (per communicative encounter) was for the emergency department staff to communicate with the patient in English (observed in 29.1% of encounters). Total time spent in communicating was highest using telephone-based interpreters (32.9% of total time spent communicating) and in-person interpreters (29.2% of total time spent communicating). Communicative mechanism also varied by care task/phase of care with the most use of interpreter services or Spanish proficient staff (as primary communicator) occurring during triage (100%) and the initial provider assessment (100%) and the lowest interpreter service use during ongoing evaluation and treatment tasks (24.3%).ConclusionsEmergency department staff use various mechanisms to communicate with LEP patients throughout their length of stay. Utilisation of interpreter services was poorest during evaluation and treatment tasks, indicating that this area should be a focus for improving communication with LEP patients.

The effect of limited English proficiency and interpreter service use on clinical outcomes in psychiatric inpatient units

Objective: The effects of limited English and interpreter use on clinical outcomes in mental health are poorly understood. This paper describes an exploratory study examining those effects across three adult inpatient psychiatric units, predicting it would lead to increased length of stay. Methods: Forty-seven patients with limited English proficiency (LEP) were retrospectively identified and compared with 47 patients with proficient English. Length of stay, number of consultant reviews and discharge diagnosis were recorded and compared. Results: An increased length of stay for those with LEP was not statistically significant ( p=0.155). The LEP group did undergo more consultant reviews ( p=0.036), however, and attracted different discharge diagnoses, with no primary discharge diagnoses of personality disorder made ( p=0.018). Conclusions: This study provides evidence of significant effects of limited English on both service burden and outcome.

Patient satisfaction of telephone or video interpreter services compared with in-person services: a systematic review

Objective This review was conducted to identify and synthesise the evidence around the use of telephone and video interpreter services compared with in-person services in healthcare. Methods A systematic search of articles published in the English language was conducted using PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Database of Abstracts of Reviews of Effects (DARE), Joanna Briggs, Google Scholar and Google. Search terms included ‘interpreter’, ‘patient satisfaction’, ‘consumer satisfaction’ and ‘client satisfaction’. Any study that did not compare in-person interpreter services with either telephone or video interpreter services was excluded from analysis. Studies were screened for inclusion or exclusion by two reviewers, using criteria established a priori. Data were extracted via a custom form and synthesised. Results The database search yielded 196 studies, eight of which were included in the present review. The search using an Internet search engine did not identify any relevant studies. Of the studies included, five used telephone and three used video interpreter services. All studies, except one, compared levels of satisfaction regarding in-person interpretation and telephone or video interpretation. One study compared satisfaction of two versions of video interpretation. There is evidence of higher satisfaction with hospital-trained interpreters compared with ad hoc (friend or family) or telephone interpreters. There is no difference in satisfaction between in-person interpreting, telephone interpreting or interpretation provided by the treating bilingual physician. Video interpreting has the same satisfaction as in-person interpreting, regardless of whether the patient and the physician are in the same room. Higher levels of satisfaction were reported for trained telephone interpreters than for in-person interpreters or an external telephone interpreter service. Conclusions Current evidence does not suggest there is one particular mode of interpreting that is superior to all others. This review is limited in its translational capacity given that most studies were from the US and in a Spanish-speaking cohort. What is known about the topic? Access to interpreters has been shown to positively affect patients who are not proficient in speaking the local language of the health service. What does this paper add? This paper adds to the literature by providing a comprehensive summary of patient satisfaction when engaging several different types of language interpreting services used in healthcare. What are the implications for practitioners? This review provides clear information for health services on the use of language interpreter services and patient satisfaction. The current body of evidence does not indicate a superior interpreting method when patient satisfaction is concerned.