When Parents of Pediatric Patients are LEP

By David Fetterolf, Stratus Video President

The use of ad-hoc interpreters in medical encounters is associated with a significant rise in communication error, particularly when a child is used to interpret. This is important to remember not only when LEP adults are the patients but also when the bilingual child is the patient. The parents of pediatric patients are the decision makers when it comes to a child’s healthcare plans. In order for parents and guardians to make informed decisions about their child’s care, they must have meaningful access to the child’s healthcare information.

When parents of pediatric patients are Limited English Proficient or (LEP), healthcare staff may be inclined to use the child to facilitate communication, as he or she is bilingual and comfortable with interpreting for the parents. It is a common practice for the child of LEP parents to help them navigate aspects of communication with English speakers. This practice in a healthcare setting, however, greatly increases the chance of communication error, one of the number one causes of adverse events in patients.

Because of this, it is most essential that children not be used to interpret. There are many cases, where a simple misinterpretation has resulted in a disastrous outcome for patients. In addition to the great risk that the practice creates, the responsibility is meant to be for a qualified professional, not for a child. Placing such a large responsibility on a child can cause significant psychological stress. Depending on the nature of the conversation, and the child’s relationship with the LEP parent or guardian, he or she may omit or alter parts of the message to make it more acceptable or pleasing to the adult. Any omission or alteration of the message could alter the LEP parent and/or provider’s perception of the situation at hand, resulting in misdiagnosis by way of the provider or misunderstanding of essential information like medication management instructions by way of the caretaker. 

In addition, the use of a child interpreter in healthcare is expressly prohibited in Section 1557 of the Affordable Care Act which states that a covered entity shall not “rely on a minor child to interpret or facilitate communication, except in an emergency involving an imminent threat to the safety or welfare of an individual or the public where there is no qualified interpreter for the individual with limited English proficiency immediately available”. This standard is one of several that were put in place to account for issues of competency, confidentiality, privacy, and other conflicts of interest that arise when providers rely on informal or untrained interpreters to facilitate communication.

Providers can take steps to prevent the use of a child interpreter by having a comprehensive language access plan in place. If the parent or guardian of a pediatric patient has a preferred language other than English that is not on record prior to an appointment or the encounter is urgent, the provider can utilize VRI to quickly reach a qualified interpreter who will appear over HIPAA compliant video within a matter of seconds.

In situations where LEP parents and guardians are the caretakers post checkup or hospital stay, it is essential for them to have a firm grasp on what information has been communicated. When LEP parents have meaningful access to their child’s healthcare information, they are equipped to make informed decisions and can more actively engage as participants in his or her care plans. Learn more about the importance of using a qualified medical interpreter in an educational webinar hosted by CMI & Language Operations Manager Betlem Nogué-Bonet, who explains the appeal of ad-hocs, the risks involved and key examples from the field.

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