LEP and Interpreter Services
A person with “limited English proficiency” (LEP) does not speak English as his/her primary language and has a limited ability to
read, speak, write, or understand English. Many d/Deaf people consider English to be their second language and are therefore considered
to have LEP.
In 2000, the President signed Executive Order 13166, “Improving Access to Services for Persons with Limited English Proficiency.” http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=2000_register&docid=fr16au00-137.pdf. This Executive Order requires Federal agencies to examine the services they provide, identify any need for services to those with LEP, and develop and implement a system to provide those services so LEP persons can have access to them ("Federal Agency LEP Guidance and Language Access Plans,"). http://www.justice.gov/crt/lep/guidance/guidance_index.html
To provide quality healthcare to individuals who are deaf, it is essential to achieve effective client/provider communications. The Americans with Disabilities Act (ADA) of 1990 (http://www.ada.gov/) requires language accommodations for people who are deaf or hard of hearing in health care settings. However, it has been shown that many providers have limited understanding of the communication needs and preferences of deaf individuals and they tend to make erroneous assumptions about speechreading, the efficacy of written notes, and the health literacy skills needed in the health care setting (Harmer, 1999). Below is a list of various methods of communicating with people who are deaf and the benefits and limitations of each. Every deaf person is unique, and the method of communication that one deaf person prefers may not work for another. When planning language accommodation, it is important to ask the person with whom you will be communicating which method they prefer.
1) TDD (telecommunications device for the deaf) and TTY (teletypewriter): These terms describe an electronic device that converts digital electronic data produced by a computer to text communication, which can assist the distance communication with deaf clients. Users of these devices type messages back and forth to each other, and these messages are transmitted through a telephone line. The term TDD is often used for digital devices in which the text is shown on a computer screen, and the term TTY is often used for manual devices in which the text is printed out on a piece of paper, like a typewriter. These methods allow people who are deaf or hard of hearing to make and receive telephone calls. However, because sign language has no written form, English must be used for these methods of communication. A hearing counselor without access to a TDD or TTY can contact the deaf client using Relay where communication is assisted by a third party who listens to the hearing individual, types the message using a TTY for the deaf individual and then reads the deaf individuals response to the hearing person.
2) The video phone is another device used in place of the telephone for communication. The video phones allow two people to communicate using ASL. Similar to the TTY Relay, there is also video relay (VRS) to facilitate communication between hearing and deaf individuals. In general, deaf people who have access to video phone prefer using the video phone to using a TTY.
3) Written notes: The efficacy of written notes depends on the English language proficiency in the individual. A disadvantage of using written notes to communicate is that information that would otherwise be spoken may not be written. Important information may be left out in the interest of time.
4) Speechreading: Some people with hearing loss rely on speechreading for communication. Using speechreading to communicate may result in miscommunication, as patients with no hearing usually read lips with only 40% accuracy (Davenport, 1977). The ability to speechread improves when an individual already has some hearing capability in place, thus, generally speaking, speechreading is not acquired by congenitally deaf persons. Speechreading may be particularly difficult in a medical setting when a patient is anxious or complex medical terms are being used. Read more about speechreading at http://www.agbell.org/docs/speechreading.pdf
5) English sign system: In this method, messages are conveyed to the deaf person word for word in English by spelling out the word using hand signals. Again, this method assumes English language proficiency.
6) ASL (American Sign Language): The ASL interpreter relays information meaning for meaning, not word for word as with the English sign system. A challenge in using this method is that health-related vocabulary that might be familiar to an English speaker may not have a corresponding sign in ASL. It is helpful to meet with the ASL interpreter before a session to make sure that he/she is familiar with the medical terms and concepts that will be used with the patient.