Environmental Scan of Interpretation Services in Kitchener, Waterloo, Wellesley, Wilmot, Woolwich

This environmental scan was developed to help advance access to interpretation services the KW4 area (Kitchener, Waterloo, Wellesley, Wilmot, Woolwich). However, it contains a literature review and information about resources that reach well beyond KW4. It was shared with the Alliance because it may be useful to other member organizations and their community & system partners. 

Initial content was drafted by Shelby McManus, Priya Vyas, Bedri Unal, and Dan Vandebelt. Further development and recommendations were drafted in discussion by members of the KW4 Ontario Health Team - Interpretation Services Workstream group.

#Executive Summary

The KW4 Ontario Health Team (OHT) formally began in 2021 with refugees being one of the three yearone priority populations. This process brought together many partners from across the community – both within and beyond the health sector – to collectively address key issues that were core to providing excellent health care in the KW4 area. Community discussions by these inter-sectoral partners identified language interpretation as a key need having a significant impact on the health of refugees and others.

While a number of ongoing, tangible activities related to interpretation in health/social/community settings continued, there was a growing desire to step back and look at the bigger picture and how we could act collectively to create a robust and effective system that supports high-quality, consistent and effective language interpretation in health/social/community settings in our area. It became evident that to do this we needed to have a clearer understanding of the current environment and options. This environmental scan seeks to provide that foundation for subsequent conversations about system approaches and creating the most effective structure to improve refugee health.

A) The scan explores the most current literature (2018-2021) and research about the need for and impacts of interpretation, finding that using trained interpreters can:

• lower clinical errors,
• lower risks of unnecessary diagnostic testing procedures and expensive tests,
• lower hospital readmission rates,
• increase referrals for appropriate complementary care, and
• increase mental health outcomes and therapeutic gains.

Overall, reviews suggested that investments in a professional language access program were cost-effective and had a positive impact in the long run, on patients, providers, and the healthcare system.

B) This scan also explores Canadian examples of system approaches for the provision of interpretation – in particular two in Ontario, one in Manitoba and one in British Columbia. These four models were similarly centralized in terms of program coordination and service delivery with similar best practice guidelines, while they had different funding structures.

C) The scan reviewed 20 professional regulatory bodies for regulatory requirements related to interpretation. The scan identified that where interpretation was not specifically named as an outright requirement, members were typically required to have clear and effective communication and ensure informed consent. Roughly half of regulatory bodies require their members to consider language barriers or use interpretation services during healthcare provision, whereas the remaining, typically have more general standards around communication.

D) Lastly this environmental scan includes data about the current state in our local community in terms of what interpretation is provided and tools currently in use. Among KW4 OHT members that responded to a recent survey, 64% used trained interpreters and most also use staff, machine translation and family/friends for interpretation. Only 1 in 4 members had an DOCS#3812158 v5a 4 organizational interpretation policy. Nine of the most frequent organization users of trained interpretation in KW4 made approximately 9,000 interpretation requests per year – covering approximately 440,000 minutes. However, there are still a number of patients that are not able to access interpretation when needed. A 2021 survey of immigrant newcomers that had low English levels in KW4 found for those that went to a hospital, clinic or health provider the in the past year and needed interpretation, 20% received interpretation supports, 17% wanted it but interpretation wasn’t provided, and 67% brought a family member or a friend.

These foundational elements can form the basis for conversations between partners regarding the following proposed recommendations toward a systemic approach to interpretation in KW4. Proposed recommendations include:

1. KW4 OHT to provide in-kind support to identify the best interpretation model of care that meets the needs of stakeholders, providers, patients and community through a highly coordinated and collaborative structure.
2. Begin exploring sustainable funding options for interpretation within the KW4 OHT signatory partnership and community partners that would benefit interpretation services (i.e. provincial health funding, member contributions – both health and non-health sector organizations, IRCC or other sources)