Medical Interpreters

When a child is ill or injured, families with limited English proficiency may be especially vulnerable to pediatric medical traumatic stress. Medical interpreters play a key role in the way that the healthcare team provides trauma-informed care. This important work in the midst of distressing situations also puts interpreters at risk for secondary traumatic stress.

Pediatric medical traumatic stress: Impact for children and families with limited English proficiency

Pediatric medical traumatic stress is a set of psychological and emotional responses that children and families may have to medical experiences. Learn more.

Many medical events or treatment procedures are scary or stressful for children and their families. And all children and families may come into a given healthcare interaction with their own concerns and fears related to:

their current medical situation, diagnosis, procedures, prognosis
past medical interactions
past trauma or challenging experiences
experiences of discrimination or bias

In the US, children and families with limited English proficiency (LEP) are more likely to have also had prior challenging experiences related to:

communicating with healthcare professionals
navigating the healthcare system
dealing with differing cultural expectations about health and about medical care
coping with difficult situations before or during migration from a home country outside the US

Language and communication challenges may put children and families with LEP at greater risk for pediatric medical traumatic stress. For some LEP families, systemic socioeconomic and racial / ethnic inequities also add risk.

Impact of language services for reducing risk of traumatic stress: What does the research say?

Pain is a risk factor for medical traumatic stress. Optimal pain management is part of trauma-informed care. But a study of children admitted for surgery found that in families with limited English, the child’s pain was assessed less frequently, and the child experienced higher levels of pain before receiving opioid pain medication. At similar pain scores, these children received less potent analgesics. Children with fewer than 2 interpreted visits per day had higher pain scores even after receiving pain medication.

Take home message: Access to language interpretation services is crucial to mitigate disparities in pain management.

Jimenez et al, 2014

Trauma-informed care: The medical interpreter's role

In any healthcare interaction, the child’s and family’s reactions and behaviors, including the way in which they communicate and take in information, can be impacted by traumatic stress responses. The medical interpreters’ role in trauma-informed pediatric care starts with this basic understanding.

A trauma-informed interpreter has received specialized training in trauma and the provision of services to those who have experienced trauma. He or she gives traumatized children and their families a voice, and provides socio-cultural, linguistically responsive services that do not re-traumatize the children and their families, but rather allow them to feel respected, safe and empowered.

Miller et al., 2019

Special considerations for medical interpreters in trauma-informed pediatric medical care

Interpreting for children. Children’s communication is impacted by their current medical status and emotional response to the situation, in addition to their cognitive / language / emotional development.
Interpreting for multiple family members. Interpreters are familiar with the ways in which family members’ language skills can differ. In healthcare interactions and medical situations, it is not unusual for parent and child to also differ in their emotional reactions and ways of coping.
Variation in healthcare team preparation. Interpreters will likely observe variation in healthcare teams’ skill and experience in providing trauma-informed care across language and cultural differences.

Interpreter Role Pyramid — **Roles for medical interpreters**

The key roles played by medical interpreters have been described as “conduit” (message passer / message converter), message clarifier, cultural broker, and advocate.

In each of these roles, interpreters can support the provision of trauma-informed care for LEP children and families.

Stress and secondary trauma for medical interpreters

Potentially stressful aspects of pediatric medical interpreters’ work

Meet children and families in times of distress or upset
May be the first person in the setting that child or parent can speak easily with, at a time when they are distressed or frustrated
May need to convey difficult or distressing news to children and families
- Interpreters may be associated and remembered by the patient/family with the message that they have to deliver on behalf of someone else (for example a life‐changing diagnosis).

May need to convey distressing or emotion-laden communication from patients / families to providers

Role challenges – real or perceived demands from patients and providers to step out of role

May have limited control over situation, message, context

Risk for secondary traumatic stress

Like other members of the health care team, medical interpreters are at risk for work-related secondary traumatic stress.

…journalists, humanitarian workers and health care providers can experience vicarious trauma because of what they witness every day. The difference is that I interpret both sides and I have to experience the feelings of those two sides. So, for example, if the doctor says something really painful to a patient, I am the one relaying the information; so to these people who don’t understand English, I am the one delivering the news. But I am also the one who interprets the reaction and the pain of the patient to the doctor.

… in the first person I feel the emotion. Because you are constantly saying “I, I, I,” you start associating with the story much more than if you were just reading or hearing about it, and you unwittingly start to absorb the trauma as if it were your own.

Simona, an interpreter quoted in “Vicarious Trauma and the Professional Interpreter”

Tips for self-care

Learn more about self-care and secondary traumatic stress for healthcare teams.

Consider creating or joining a peer supervision group.

Organizational responses

In addition to organizational support for all healthcare staff, the following are especially relevant for language services staff.

Building organizational policies and culture that
- foster inter-professional partnership with healthcare team
- include interpreter perspectives in policies that impact them
Considering balance and diversity in interpreter workload / case assignment
Ensuring a supportive supervisor‐interpreter ratio
Providing preparation for, and debriefing after, stressful situations - for staff interpreters and for contracted interpreters
Offering post-session debriefing after particularly challenging situations, to allow interpreter to process a challenging situation while honoring patient confidentiality
Considering needs of interpreters who work remotely
Requiring contracted organizations to provide appropriate support for interpreter well-being

More information and resources

Interpreters and trauma-informed pediatric care

A Socio-Culturally, Linguistically-Responsive, and Trauma-Informed Approach to Mental Health Interpretation. Miller et al. (2019), National Center for Child Traumatic Stress.

Comprehensive resource and training tool. Focus is on interpreting in mental health services, but many aspects are relevant for medical interpreting.

Secondary Trauma

Vicarious Trauma and Interpreters. From the American Translators Association (ATA) Interpreters Division (February 2020)

Information and resources on vicarious trauma in interpreting, categorized by type (sign language, medical interpreting, etc), includes links to relevant resources:

Tools for Interpreters From “Wellness Connection: For Interpreters by Interpreters” blog by MasterWord (private company).

Wellness tips and tools for interpreters on managing stress and secondary trauma.

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Pediatric Medical Traumatic Stress

Patient Education

Screening & Assessment

Intervention

Trauma-Informed Care

COVID-19

Resources

Impact of language services for reducing risk of traumatic stress: What does the research say?

Take home message: Access to language interpretation services is crucial to mitigate disparities in pain management.