"New iPad system for deaf patients at Derriford leaves Plymouth family 'frustrated and upset'"

Well, there's a lot more to this story in The Herald than the press would have you believe.

Derriford Hospital have been trialling iPads with which non-signing hospital staff and signing patients and their families can communicate using SignLive's video remote interpreting service. It has proven to be problematic in some ways. Internet connectivity across the hospital site appears to be patchy (though I wonder if issuing a powerline extender with each iPad could be a simple workable solution), some patients are not used to or comfortable with tablet technology or remote interpreting for various reasons, and - perhaps most importantly - Deaf patients (and perhaps some interpreters) have become suspicious that the cheaper and more immediate SignLive provision is a way to cut costs, thus removing from the Deaf person the choice to have a live interpreter in the room with them.

Not mentioned in the article is the separate issue that the hospital trust has agreed a contract with an interpreting agency that has become extremely slow to pay the interpreters for work done on their behalf at the hospital. Some interpreters remain unpaid and many interpreters in the area have taken the difficult decision to not accept assignments from that agency because they need to make a living. The hospital trust is unable to make interpreter bookings directly with the interpreters or via other agencies because of their contractual commitment to this particular agency. The consequence of this is that it is very difficult for the trust to use live interpreters, and they are left with just the iPad/SignLive solution, which the end users are unfamiliar with and continues to suffer from snags.

I understand that the hospital trust is looking into that contract in an effort to resolve this failure of interpreter provision.

I think the trust should be commended for embracing video remote interpreting (VRI). The issue of their being locked into a contract with a provider of live interpreting that cannot deliver has become mixed up with the separate issue of VRI. It is important that the use of live interpreters and the use of VRI be considered separately. Yes VRI might be preferentially used by financially constrained public services but are they? I hope that the trust has an open and publicly accessible policy for when they do and do not offer VRI or live interpretation. Historically, when only live interpretation was available, Deaf patients would be highly unlikely to have interpreted access to their care in A&E, at reception, or anywhere a wait of a few days to a few weeks for an interpreter to become available would be inevitable. VRI in principle puts a sign language interpreter into places they have never been, and this is a widening of accessibility, not a narrowing.

There is a net narrowing at present in that hospital because of the problems with their chosen interpreting agency. Hopefully by being open about their interpreting policy and consulting with the local Deaf Community patients will see that VRI provides more access, not less.

Jim Cromwell
Care Act (2014) Training

My sister is a really good trainer on social care, and particularly the Care Act 2014. She has a background in Deafness as a care home manager for the RNID and continues to be highly Deaf-aware. 

She has been delivering Care Act training since it became law, and has found that when Deaf people are being trained, the material and the training process is not as accessible as she would like. This is the case even with a Deaf-aware trainer and good, experienced interpreters with lots of preparation opportunity.

Alex MacNeil

Alex MacNeil

She and I are looking at running a Care Act training day for Deaf people, which will be created from the beginning with Deaf people and BSL in mind (rather than interpreting a hearing course.) At this stage we are just trying to find out if that is something that people want.

Please share this post with any Deaf social workers or other Deaf people you know who are interested in or work within the Care Act.

There is no obligation to take part or do anything - but if you can let us know your thoughts, if you think there are enough people interested to set this up, or if you have your own ideas about how to make the Care Act accessible, please let us know. Comment below, or email, or use the contact options here.

Jim CromwellComment
Hearing Voices

This is a moving article from Karen Sinnott in The Journal via @JeminaNapier in which she talks about the experience of mental health care as a Deaf person in Ireland.

When you start to work with Deaf people with psychosis, as I did in 1996, you learn very quickly that 'deaf people with psychosis often hear voices', and it takes a long time (well - it took me a long time) to ask what does that mean and how do you know? 

Diagnosing psychiatric disorder is hard. It is exponentially harder with a Deaf patient - even if you are a Deaf clinician - because the definition of schizophrenia (for example) is based upon statistical analyses of symptoms described at interview by hearing patients to hearing researchers, and so the diagnostic criteria come from a fundamentally hearing phenomenology of psychosis. A clinician will ask "do you hear voices" and the patient will say yes (or no). For hearing clinicians and patients what they each mean by the English word "voice" likely has considerable overlap, and - arguably - that answer suffices.

For a Deaf person, in a signed clinical interview, you do not have that shared vocabulary. Signing clinicians, or interpreters, have to make an interpreting decision about how to ask that question in BSL/ISL. Do you sign voice with a mouth-like handshape, or a V-hand? Where do you sign it? At the throat? Near the ear? In a neutral space (if there is one)? Is your sign more akin to talk as opposed to speak? Given time and care, you need to ask a series of many specific questions about the language of the 'voice', the modality, the location, the patient's confidence in their own description and so on, and then base the diagnosis on that. If you are interviewing via an interpreter, that whole process becomes all the more complicated, and potentially also opaque. My friend, and genius, Jo Atkinson has researched this and published on it, for example here.

But to me it leads to more fundamental questions about the nature of communication and interaction. Is it sufficient to assume that the person means the same thing as you when you say "voice"? We naturally do this in conversation; we use highly familiar catch-all terms that, because we use them all the time, we assume that any pair of us means the same thing by that word. Only much later on in the conversation, if at all, do we realise we have been talking at cross-purposes.

What does your Deaf patient mean when they report 'hearing voices'?

And why, when we are super-cautious about taking as read the patient's claim of being followed at all times, or of being an African prince, are we so wiling to accept at face value their claim to be hearing voices?

NOTE: This post is in no way intended to doubt Karen's own account of her own particular experiences. Rather I thank her for her important and courageous article, and the opportunity it presents to me to raise broader questions.

Jim Cromwell
Sign Language Interpreting: Engaging the Disengaged, Empowering the Disempowered

This is an absolutely fascinating (interpreted) article by Tom Holcomb on StreetLeverage recently, interpreted from his ASL at StreetLeverage – Live 2017.

He clearly identifies the ways in which interpreters' paradigms of message equivalence and interpreting accuracy disempower the deaf person (when ASL is the minority language in the room. I am interested in how these effects change when the language ratio is equal or inverted) -

Often the blame goes to hearing people who have no clue how to properly support deaf people’s participation. In casting the blame on the non-signing hearing participants, we have avoided taking a hard look at the current standard practice of interpreting to see if the deaf people are actually unintentionally disempowered by the interpreters on hand.

He continues...

The current twenty-minute switching standard was based on research regarding interpreters’ mental fatigue. The findings have shown that fatigue causes increased interpreting errors and physical challenges that resulted in hand injury. Yet, there is no research on the impact of these switches on deaf people’s ability to comprehend the interpreted message or their ability to participate effectively in the interpreted session...

The optimal system, for me, is to have both interpreters working simultaneously with the work rotated every time a new speaker has a turn rather than rotating based on the time intervals of 20 minutes. By seeing a different interpreter for every speaker, I find myself much more engaged in the meeting. I also find it easier to participate when the second interpreter is available to interject my message immediately if the first interpreter is busy with the Spoken English to ASL interpretation for the current speaker.

Read the whole article here on Street Leverage. It is excellent.

Jim Cromwell