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Deaf communities are as diverse as any other patient population – culturally, linguistically, and socially – and there are many important factors to consider related to healthcare and communication. As with other underserved healthcare minority groups, deaf people are at higher risk for experiencing serious healthcare disparities as compared to the general population. Signed language interpreters with specialised training in healthcare can contribute to reducing those disparities through multiple channels. However, interpreters are not the only avenue available to deaf patients seeking healthcare and, in many cases, using a language-concordant provider or a healthcare programme that is run by and for deaf people may be the preferred choice for the patient. In this chapter the systems within which qualified healthcare interpreters work and their impacts on the health of the Deaf and Hard of Hearing community are explored. Historical perspectives and critical issues in healthcare interpreting are described, as well as the means through which professional interpreting can impact deaf health outcomes. The chapter also addresses the significance of interpreters for deaf professionals seeking training and practice as clinicians, leading to critically important language concordance between deaf clinicians and deaf patients.

Despite federal laws that mandate equal access and communication in all healthcare settings for deaf people, consistent provision of quality interpreting in healthcare settings is still not a reality, as recognized by deaf people and American Sign Language (ASL)-English interpreters. The purpose of this study was to better understand the work of ASL interpreters employed in healthcare settings, which can then inform on training and credentialing of interpreters, with the ultimate aim of improving the quality of healthcare and communication access for deaf people. Based on job analysis, researchers designed an online survey with 167 task statements representing 44 categories. American Sign Language interpreters (N = 339) rated the importance of, and frequency with which they performed, each of the 167 tasks. Categories with the highest average importance ratings included language and interpreting, situation assessment, ethical and professional decision making, manage the discourse, monitor, manage and/or coordinate appointments. Categories with the highest average frequency ratings included the following: dress appropriately, adapt to a variety of physical settings and locations, adapt to working with variety of providers in variety of roles, deal with uncertain and unpredictable work situations, and demonstrate cultural adaptability. To achieve health equity for the deaf community, the training and credentialing of interpreters needs to be systematically addressed.

Little is known about the nature of fingerspelling during sign language interpretation. In this small-scale, exploratory study, we examined the fingerspelling of interpreters working in five different sign languages: American Sign Language (ASL), Australian Sign Language (Auslan), British Sign Language (BSL), Irish Sign Language (ISL), and Italian Sign Language (LIS). Sixteen interpreters were video-recorded as they rendered President Barack Obama’s 2009 inaugural address in their country’s sign language. After completing their interpretations, the participants engaged in a retrospective interview about their work. The data were analyzed both quantitatively (for frequency and type of fingerspelling) and qualitatively (for factors influencing fingerspelling). Results indicate that the most fingerspelled items ( n = 137) were produced in the ASL interpretations and the fewest ( n = 18) were produced in the LIS interpretations; variation between the groups was found in lexicalized fingerspelling and the fingerspelling of place names. We suggest that the variation in fingerspelling both within and between groups may be explained by sociolinguistic factors, including interpreters’ language attitudes and perceptions of the deaf audience. This exploratory study provides a first step in investigating the fingerspelling of interpreters in a variety of sign languages.

The number of deaf people earning degrees and credentials to work in the healthcare setting has been increasing in recent years, due both to legislation and technological advances that have removed some of the barriers to education and employment. However, there have been few studies that investigate how the work of the interpreter may differ when the healthcare professional is deaf, not the patient. Based on a job analysis approach, deaf healthcare professionals responded to an online survey and rated the importance of and frequency of 51 task categories for the interpreters with whom they work. The results were compared to previous research findings from the perspective of interpreters. There appear to be some similarities and differences in how interpreters and deaf healthcare professionals perceive the importance and frequency of task categories for interpreting in healthcare settings. Five themes included task categories related to employing language, adapting to a variety of physical settings, using healthcare-specific knowledge, assessing situations, and dealing with or openness to unpredictability and uncertainty. We discuss implications of the similarities and differences related to understanding the work of healthcare interpreters from multiple perspectives, as well as implications for training and education.

This study examined omissions, errors, and variability in lexical selection across simultaneous interpretations of President Obama’s 2009 inaugural address, in three spoken languages (French, German, Japanese) and in American Sign Language (ASL). Microanalysis of how information conveyed by 39 source speech lexical items was transferred into the target languages assessed to what extent omissions and errors reflected differences in lexical structure (relative frequency of ready lexical correspondents and of shared cognates between the source and target languages; and, for ASL in particular, size of lexicon compared to English). The highest number of errors and omissions was found in ASL, which has the smallest documented vocabulary, fewest lexical correspondents, and no shared cognates with English. If omission/error rates in interpretation of lexical units are taken as a rough indicator of interpreting difficulty, results suggest that it is more difficult to interpret the speech into Japanese than into French or German and, by the same token, more difficult to interpret it into ASL than into the three spoken languages. These findings are consistent with the idea that language structures impact cognitive load during interpreting, and that interpreting effort increases in relation to the degree of difference between the source and target languages.

In this study we examine linguistic features produced by interpreters and deaf bilingual physicians when translating medication instructions from English into American Sign Language (ASL). In the U.S. healthcare system, signed language interpreters are frequently called upon to facilitate communication between deaf individuals who use ASL and their non-signing physicians. A small but growing number of deaf individuals are now pursuing medical training, creating a situation in which deaf patients can communicate in ASL with their healthcare providers. Numerous practical and perceptual barriers affect patients’ medication intake behaviors, including comprehension, memory of instructions, and language differences between physicians and patients. Research indicates that language concordance increases patients’ compliance to prescription treatment. It follows that direct communication in ASL between deaf patients and deaf physicians will positively impact treatment compliance of patients and may result in better recall of medical instructions. We examined the linguistic features used in English to ASL translations of two medication directions as produced by experienced ASL-English interpreters (n=3) and deaf bilingual physicians (n=3). Results showed the absence of a standard approach for translating medication directions into ASL; however, both groups incorporated the same linguistic devices to promote emphasis within the translation, including repetition, emphatic lexical signs, and prosodic markers, presumably to promote recall of key concepts by deaf patients. Lexical variability in the translations is discussed, as well as information gaps between the ASL and English versions of the medication instructions. The results hold implications for healthcare professionals, interpreters, and interpreter educators for building effective communication for deaf patients.

1. Preface 3. Introduction (by Swabey, Laurie) 4. Researching interpreting: Approaches to inquiry (by Pochhacker, Franz) 5. Designing a research project: Beginning with the end in mind (by Russell, Debra) 6. Identifying and interpreting scientific phenomena: Simultaneous challenges to interpreting research (by Moser-Mercer, Barbara) 7. The first three years of a three-year grant: When a research plan doesn't go as planned (by Metzger, Melanie) 8. Methodology in interpreting studies: A methodological review of evidence-based research (by Liu, Minhua) 9. If a tree falls in a forest and no one is there to hear it, does it make a noise?: The merits of publishing interpreting research (by Napier, Jemina) 10. "Mark my words": The linguistic, social, and political significance of the assessment of signed language interpreters (by Leeson, Lorraine) 11. Developing and transmitting a shared interpreting research ethos: EUMASLI - A case study (by Hessmann, Jens) 12. Profession in pentimento: A narrative inquiry into interpreting in video settings (by Peterson, Rico) 13. Through a historical lens: Contextualizing interpreting research (by Adam, Robert) 14. Bimodal bilingual interpreting in the U.S. healthcare system: A critical linguistic activity in need of investigation (by Swabey, Laurie) 15. Index

This chapter focuses on non- professional interpreting and translation performed by children from migrant backgrounds, between healthcare providers who speak the host country’s language(s), and their own families and/or communities who may lack the necessary proficiency in these language(s). We will first offer a definition of this type of interpreting and translation, called Child Language Brokering (henceforth, CLB) in general (Section 1). We will then review the legal frameworks (Section 2) and the literature on CLB, specifically within the healthcare sector (Section 3). Finally, before reflecting on future directions, we will present some of the findings of our own research on CLB in Italy, with special reference to healthcare (Section 4).