In this workshop, we discuss the use of demand control schema (DCS) as a framework for making ethical decisions in interpreting and as a strategy for professional development. Within healthcare, there are a wide variety of specializations. While it is not realistic to expect that interpreters be intimately familiar with all of these settings, they are often faced with the challenge of navigating the demands in unfamiliar medical environments. This workshop examines strategies used by interpreters to facilitate effective communication in one of these specialized settings – genetic counseling. Traditionally, interpreter training programs focus on the technical aspects of the job, along with an emphasis on rule-based approaches to ethical decision making. However, ethical decisions require thoughtful consideration and reflection of the entire setting, including linguistic skills, ongoing analysis of the subject matter, interaction among discourse participants, cultural knowledge, and the resilience to make moment-by-moment decisions. This workshop exemplifies that interpreters who are well versed in DCS are better equipped to analyze the interpreting situation than those without DCS training. A structure will be provided for discussing the work using non-judgmental, evaluative, concrete language, which can be used for guiding interpreters to recognize the impact they have on the interpreting environment Interpreter trainers will gain an appreciation for their responsibility to impart the concept of interpreting as a practice profession that requires professional development, including mentoring and performance feedback, throughout the professional interpreter’s career. Learning Objectives: To recognize the components of interpreting that categorize it as a practice profession. To understand the use and benefits of DCS for effective interpreting practice, and ethical decision-making in content-specific medical specializations, such as genetic counseling. To learn about the importance of supervision in practice professions and how to utilize the DCS framework for effective supervisory conversations.

1. NATIONAL
COUNCIL
ON
INTERPRETING
IN
HEALTH
CARE

2. NATIONAL
COUNCIL
ON
INTERPRETING
IN
HEALTH
CARE
Housekeeping
• This session is being recorded
• Certificate of Attendance
*must attend full 90 minutes
*certificates will be emailed by
September 22, 2021
• Use “Q&A” to send comments and questions
to the hosts
Home for Trainers Interpreter Trainers Webinars Workgroup
An initiative of the Standards and Training Committee
www.ncihc.org/home-for-trainers

3. NATIONAL
COUNCIL
ON
INTERPRETING
IN
HEALTH
CARE
Welcome to our guest presenter!
Debbie Lesser, MS, CI/CT, QMHI, CoreCHI

4. Interpreting:
A Practice Profession
Improving Professional Performance with Demand Control Schema
Debbie Lesser, MS, CI/CT, QMHI, CoreCHI
debbie.lesser@wellstar.org
404-226-5607

5. Encounters with
Reality
1001 Interpreter
Scenarios
Barabara E. Cartwright
“Once one has mastered
(sign) language, the
mechanics of interpreting,
and internalized the Code
of Ethics, the really
difficult work begins.”

6. Practice Professions
 Doctors/Nurses
 Teachers
 Social Workers
 Lawyers
 Interpreters –
➢ Must understand contextual factors of our work
➢ The relationship between consumers and interpreters
➢ Requires flexibility in the encounter
➢ Requires ongoing analysis and judgement
It is the technical skill
of being able to process
language that makes an
interpreter effective in
an assignment

7. Metaphors & Roles ….what are we really
trying to communicate?
How We Describe Ourselves
❖ Invisible
❖ Operator
❖ Machine
❖ Telephone
❖ Window
❖ Bridge
❖ Helper
How the Interpreter Behaves
❖ Conduit
❖ Moderator
❖ Cultural gate keeper
❖ Co-diagnostician
❖ Clarifier
❖ Manager
❖ Welcomer
❖ Professional Communicator
❖ Language Facilitator
You can’t measure the size of a room with the color blue.
-Robyn Dean

8. Supervision – aka…
 Reflective practice
 Case conferencing
 Peer guidance
 Professional consultation
 Mentoring
Supervision provides
guidance to enhance
one’s knowledge,
skills, and attitudes,
and allows the
supervisee to reflect
on ethical issues
from various
perspectives.
➢ Discuss the work for the purpose of improvement (ethics)
➢ Discuss possible options available and how effective those options are
➢ Discuss actions taken & resulting consequences (Did the intended result occur?)
➢ Re-examine our values, principles & beliefs
➢ Learn from the decisions made
Supervision – purpose

9. Patient Meeting with Genetic Counselor

10. Demand-Control Theory – Robert Karasek
characteristics of the job that impact health and wellbeing
Low Strain
Jobs
Active
Jobs
Passive
Jobs
High Strain
Jobs
High
Low
Low High
Job decision latitude
(Controls)
Job demands
Learning motivation
to develop new
behavioral patterns
Risk for psychological
and physical stress
Mulder, P. (2017). Job Demand Control Model by Robert Karasek. Retrieved from ToolsHero:
https://www.toolshero.com/human-resources/job-demand-control-model/

11. Demands
Environmental
That which is specific to the
setting (e.g. professional roles,
terminology, goal/purpose of the
setting, physical surroundings )
Interpersonal
That which is specific to the
interaction of the consumers and
interpreter
Paralinguistic
That which is specific to the
expressive skills or qualities of
the consumers, deaf or hearing
Intrapersonal
That which is specific to the
feelings or thoughts of the
interpreter

12. Controls
Pre-Assignment Controls
Assignment Controls
Post-Assignment Controls
Race - Gender – Ethnicity - Education - Work Experience – Preparation – Clothing Choice
Positive self talk – Direct Interventions – CPC/COE – Identifying Demands - Interpretation
Debriefing – Supervision – Further Education – Follow-up with people involved – Self Care

13. Ethical and Effective Decisions
Too Liberal
Therefore,
ineffective
and/or
unethical
Effective & Ethical
Decision-Making
Too
Conservative
Therefore,
ineffective
and/or
unethical
Liberal - favoring action, creativity, assertiveness
Conservative - favoring inaction, reservation, patience

14. Main Demand – what would you do if….
Main Demand
Concurrent
Demand
Concurrent
Demand
Concurrent
Demand
Concurrent
Demand
Concurrent
Demand

15. The Science Lesson….

16. Traditional Feedback in Supervision
You did a good job. It went well.
 Interpreters can’t improve with non-specific feedback
 Traditional feedback tends to be judgmental vs. analytical in nature
 Traditional feedback tends to focus on the interpreter’s actions rather than
the demands & controls
➢ Provides a framework to assist the supervisee in evaluating their own work
➢ Feedback is specific based on requirements of the job and interpreter’s
decision latitude
➢ Enables case conferencing regardless of whether supervision leader and
supervisee speak the same language
➢ Considers potential resulting demands once control decisions were made
Demand Control Schema

17. Conclusions From My Research
 Interpreters who are well versed in Demand Control Schema (DCS) are better
equipped to analyze the interpreting situation more robustly than the untrained
interpreter.
 The DCS trained interpreters appeared to be able to separate themselves from their
work, thus allowing them to focus less on intrapersonal demands and more on the
other demands of the setting.
 Providing interpreters with the opportunities to become more experienced with
DCS, potentially through Reflective Practice and Supervision sessions, could improve
the experienced interpreter’s ability to process the work environment more
robustly, enabling them to learn from their experiences and improve their decision-
making strategies in future assignments.
 DCS trained interpreters considered the thought world of the provider, including
their goals in the moment significantly more than untrained interpreters
 Untrained interpreters were less likely to consider potential resulting demands once
control decisions were made.
 DCS trained interpreters were able to verbalize twice as many interpersonal
demands between patient and provider as compared to untrained interpreters.

18. Q & A
The Demand Control Schema: Interpreting as a Practice Profession 1st Edition
by Robyn K. Dean (Author), Robert Q Pollard Jr (Author)

19. NATIONAL
COUNCIL
ON
INTERPRETING
IN
HEALTH
CARE
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Home for Trainers Interpreter Trainers Webinars Workgroup
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www.ncihc.org/home-for-trainers

20. NATIONAL
COUNCIL
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INTERPRETING
IN
HEALTH
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Thank you for attending!