More than 40% of children with hearing loss come from families in which English is not the primary language of the home, according to the Gallaudet Research Institute. Yet, there are relatively few bilingual speech-language pathologists with experience to serve this growing segment of the early intervention population through an auditory-based approach. As a result, monolingual, English-speaking SLPs will rely increasingly on interpreters and/or translators to serve the needs of infants and toddlers with hearing loss in early intervention settings.
But integrating an interpreter into any therapeutic environment often prompts a host of accommodations. This situation is certainly true for families pursuing auditory-based intervention, which focuses on listening and spoken language outcomes rather than on the use of manual communication. An auditory-based approach closely monitors the auditory characteristics of natural conversation to facilitate a child's spoken language processing—so the clinician must use the interpreter effectively.
Here are five key factors to consider when using an interpreter in an auditory-based intervention program:
1. Know when an interpreter is needed.
Within a family-centered early intervention framework, the primary caregiver occupies the central role in the child's treatment program. Parents not only promote their children's auditory and/or language skill development through techniques and strategies acquired in therapy, but also support collaboration among service providers. Therefore, parents must be able to gain knowledge, ask questions, and share ideas or strategies in a language in which they are comfortable and highly proficient.
For this reason, the caregiver's level of English language proficiency should weigh heavily in the decision to use interpretation. Also, even if a parent is English-language proficient, the family may desire a different language as the "language of intervention" based on additional factors, such as the family's country of origin, length of stay in the adopted country, languages of the home, and the child's preschool setting.
But how do you determine whether parents have proficient English skills for the purpose of asking questions, sharing ideas, and/or actively participating in treatment? Prior to the first session, ask family members whether they have used an interpreter for other services. You may also consider previous telephone or e-mail conversations, or the written case history provided by the family, when establishing if an interpreter's services are needed.
In most instances, judge the family's skills conservatively and provide extensive support with interpretation at the outset of treatment; you can always remove these supports later. Ideally, parents involved in their child's early intervention services should demonstrate a cognitive academic language proficiency (CALP) in English before interpretation and translation services are dismissed. CALP-level skills suggest that the caregiver can not only converse effectively during daily social interactions but also share and learn new—even complex—knowledge within that language. They are also more apt to understand, use, read, and write in that language.
2. Always hire a trained professional.
Terminology for conventional concepts or techniques used in auditory-based learning—like auditory bombardment or acoustic highlighting—may not exist in the family's native language. You will need to develop shorthand for such terms over time with your interpreter. Repeated use of a trained professional—who can also adapt his or her delivery to the specific dialect of the family, if necessary—is the best way to achieve this.
A collaborative relationship with the interpreter is also vital when deciphering how social customs, religious beliefs, and/or gender roles inform the family's communication style. How prevalent are children's songs and rhymes in their culture? Which hand do you offer when greeting the child's father? Should you make direct eye contact when speaking to someone of the opposite sex? These and other questions can usually be addressed by a skilled interpreter. In effect, the interpreter then serves as a "cultural broker" who supports your efforts to establish a healthy rapport with the family and child from the outset of treatment.
3. Plan your assessment in consultation with the interpreter.
An optimal speech-language test battery for a child with exposure to multiple languages should incorporate standardized and informal test measures. You can ask the interpreter to provide written translation of a child's spontaneous language, or to translate language samples provided by the parent. You should also provide some training to the interpreter and/or family on how to transcribe the child's utterances to ensure accurate sampling.
English-language exposure for non-English-speaking families can vary dramatically relative to their region or community, but tends to be fairly extensive in most areas of the United States. As such, it is usually necessary to perform standardized English test measures with—at the very least—informal assessment of the child's skills in another language by the interpreter. For example, you could ask the child a test item in English and then, after the child provides a response, the interpreter could ask the same test item in a second language. This strategy most commonly is used when a child provides an incorrect response, but could be used throughout an assessment—although this may cause fatigue in a very young child.
It is critical that you retain the test results from the items scored in the second language as informal diagnostic information gathered chiefly for the purpose of establishing treatment goals. (Standard scores should never be reported for test items administered in a language other than that used in the normative data sample, except where the test manual allows.) Regardless of the type of measure, you should provide clear direction to the interpreter prior to the assessment—for example, advise against modifying test language except where permissible and discourage the use of facilitative language techniques that the interpreter may have observed in treatment.
4. Customize the interpretation mode to the session's needs.
Interpretation, in practice, refers to facilitating spoken communication in real time between two different languages (as opposed to translation, which refers to the conversion of a written document or message from one language to another). An interpreter's function is to convey information from the source language to the target language while preserving the meaning of the original message. In an auditory-based intervention program, choose an interpretation mode that best meets the needs of the child and family.
In consecutive interpretation, the interpreter conveys the message in the target language after the source-language speaker finishes talking. In this type of interpretation, all speakers must be aware of their messages' lengths and pause to allow for interpretation. Because each message is essentially stated twice, you may wish to allot additional time for sessions requiring extensive consecutive interpretation. It is also necessary to slow the overall rate of conversation so that the child with hearing loss has sufficient time to process language occurring within that environment. The key benefit of this mode of interpretation is that it allows you to provide more immediate feedback to the child and family; it also can be very effective for infants and toddlers early on in their linguistic development, when less complex language models are needed.
Simultaneous interpretation occurs when the interpreter renders the message as soon as he or she can formulate all or some of it in the target language. In standard practice, the original speaker has not yet finished his or her statement. Not surprisingly, simultaneous interpretation is strongly discouraged during any auditory-based intervention program unless it is incorporated as "whispered interpretation."
In whispered interpretation, the interpreter sits alongside the caregiver and whispers directly to him or her in the caregiver's native language. The interpretation does occur simultaneously but it is very soft. To further minimize the auditory distraction of simultaneous interpretation, the caregiver and interpreter can sit slightly away from the interaction—but in the same room.
Although this mode customarily does not allow for much interaction between speakers of different languages, it provides for longer conversational exchanges and the development of complex language within the session. You can provide language stimulation and directly engage the child in English, while the parent listens to a whispered interpretation of the exchange. Or the parent can lead an activity in the family's native language while you listen to a whispered interpretation in English. As long as you include some time following each interaction to debrief the caregiver about the strategies and techniques employed during the exchange, whispered interpretation can be an effective and time-saving alternative to consecutive interpretation.
5. Model effective communication skills.
Some parents may develop an immediate bond with the interpreter as a communication partner who shares a similar linguistic and/or cultural background. At the same time, you might feel encumbered in your attempts to establish a productive rapport with the parent and child, given that another person is conveying the informational content of most social interactions.
However, the emotional content of each message remains entirely in your hands. You should model effective communication habits in each session to establish and promote a healthy rapport with the child and family. Remember to pause between conversational turns, refrain from interrupting others, and, most important, look at the person you are addressing. Making culturally appropriate eye contact while addressing or listening to your communication partner is perhaps the most intangible aspect of nonverbal communication—with or without an interpreter. Although parents may not reciprocate all these courtesies during conversation, you should model them continually.
In every session, you will need to address the auditory and spoken language needs of the infant and toddler while maximizing the parent or caregiver's role in the child's habilitation program. When used effectively, an interpreter can go beyond merely assisting in this process to significantly enrich the clinical experience by broadening access to services for linguistically diverse families.