This Practice Portal page focuses on the roles and factors that audiologists, speech-language pathologists (SLPs), and assistants consider when working with interpreters, transliterators, and translators. This page is understood best in relation to the companion Practice Portal page on Multilingual Service Delivery in Audiology and Speech-Language Pathology.
Visit ASHA’s resource on communication access for more details on supporting communication to provide quality care.
This Practice Portal page will use the term, “patient,” to capture the variety of people—including clients and students—that clinicians encounter in clinical interactions. The term, “care partner,” includes families, caregivers, and care partners that support the person receiving audiology or speech-language pathology services.
Linguistic diversity in the United States is growing with 22% of the U.S. population—over 67 million people—who use, or are exposed to, more than one language (Dietrich & Hernandez, 2022). During the 2020–2021 school year, 11.78% of elementary and secondary students with disabilities who were served under an individualized education program were identified as English learners (U.S. Department of Education, 2022). From 2020 to 2021, 50 different languages were requested for health care interpretation services across the United States, including—but not limited to—Spanish, Vietnamese, American Sign Language, Arabic, Mandarin, and Russian (AMN Healthcare, 2021). Conversely, ASHA-certified audiologists and SLPs reported in a survey that access to interpreters and translators is one of the main supports they need to improve quality of care (ASHA, 2023a).
Audiologists, SLPs, and assistants will likely work with patients and care partners who use languages that are different from their own. Language barriers reduce the quality of health care, patient safety and outcomes, and provider and patient satisfaction with medical services (Al Shamsi et al., 2020). Therefore, providers collaborate with an interpreter, a transliterator, or a translator to ensure access to quality services for everyone. Legal and ethical standards require that services to people who use a language that is different from the provider must be delivered in the language most appropriate to that student, patient, or family.
Communication access promotes effective communication and reduces communication barriers so that people with communication disabilities can take part in, and fully benefit from, quality services and programs. Communication supports can include different communication methods (e.g., gestures, writing, pictures) and communication aids and services as required by law. Visit ASHA’s resource on communication access for more details on supporting communication before starting care. Promoting communication access may also include language access and language assistance.
Language access refers to promoting and ensuring meaningful access to information and services, regardless of a person’s ability to speak, understand, read, or write English. This includes a patient’s and/or care partner’s
Language access includes planning, policies, procedures, and resources dedicated to equitable access to services for people who use a variety of spoken and signed languages. To provide language access, clinicians and organizations often offer language assistance services.
Language assistance refers to the ways needed to facilitate communication with people who do not use spoken English and/or people with disabilities (U.S. Department of Health and Human Services, 2023). Language assistance services may be required for culturally and linguistically appropriate multilingual service delivery. Examples of language assistance include
Services may be delivered in person, by video, or by telephone. When language assistance is necessary, a clinician is still responsible for planning the session, selecting culturally relevant materials, and appropriately administering the services. It is the legal and ethical responsibility of the facility and its providers to offer reasonable and appropriate accommodations to facilitate access to clinical services.
Overall, communication access and language access are about building equitable systems to make services and information accessible and achievable for all.
Language assistance providers are the professionals who provide interpretation, transliteration, and/or translation services. Clinicians are responsible for considering the goals of the session; discussing the patient’s or care partner’s needs; evaluating how to engage a patient’s languages to best facilitate goals; and determining the optimal interpreter, type of interpreting, and tools needed to assist in the provision of services (Langdon & Saenz, 2016).
Each type of language assistance provider is defined below.
Interpreter—a person trained to convey spoken or signed communications from one language to another. Interpretation services may be provided
Although apps may be available via electronic devices, they do not meet the federal requirements of a qualified interpreter (45 C.F.R. § 92.4). Section 1557 of the Affordable Care Act (2024) defines a qualified interpreter for an individual with a disability as the following (45 C.F.R. § 92.4)
Oral transliterator—a person trained to facilitate communication for individuals from one form to another of the same language. This person usually works with individuals who are d/Deaf or hard of hearing who use oral, cued, or manual communication systems rather than formal sign language. Oral transliterators differ from interpreters in that interpreters generally receive information in one language and interpret that information in a different language.
Translator—a person trained to translate written text from one language to another. At times, the interpreter or transliterator may be asked to also provide translation services. However, translation requires different skills from interpreting and transliterating. Unless the interpreter is also a translator, the clinician should not expect this. Some qualified professional interpreters do not feel comfortable doing sight translation or written translation.
State and federal regulations, along with industry standards, mandate equitable access to services regardless of the language(s) used. Several state and federal regulations have implications for audiologists, speech-language pathologists (SLPs), and assistants collaborating with interpreters, transliterators, and translators. These legal requirements aim to ensure that all patients receive high-quality, accessible health care services and promote better health outcomes. For more information, visit ASHA’s resource on understanding language access requirements for audiologists and SLPs.
Rights to language access may come from multiple pieces of legislation. As of 2019, every state and the District of Columbia have at least three laws addressing language access (Youdelman, 2019). Differences in state regulations may be reflected in several requirements. See the National Health Law Program’s Summary of State Law Requirements Addressing Language Needs in Health Care.
The Americans with Disabilities Act of 1990 (ADA) prohibits discrimination and ensures equal opportunity for persons with disabilities in the areas of employment, state and local government services, public accommodations, commercial facilities, and transportation. Congress has mandated the need for auxiliary aids and services—such as interpreters, transliterators, and translators—to ensure equal opportunity for individuals with disabilities (Americans with Disabilities Act of 1990). To confirm compliance, consult ADA’s Checklist for General Effective Communication.
The Equal Educational Opportunities Act of 1974 states, “All children enrolled in public schools are entitled to equal educational opportunity without regard to race, color, sex, or national origin.” No state can deny students the right to equal education by “failure by an educational agency to take ‘appropriate action’ to overcome language barriers that impede equal participation by its students in its instructional programs” (Equal Educational Opportunities Act of 1974).
For school-age children, the Individuals with Disabilities Education Act (IDEA) was enacted to ensure that all children with disabilities (ages 0–21 years) have a free and appropriate public education available that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment, and independent living.
Part B
IDEA states that, in the development, review, and revision of an individualized education program (IEP), the team must consider several factors with regard to interpreters:
(iv) consider the communication needs of the child, and in the case of a child who is deaf or hard of hearing, consider the child’s language and communication needs, opportunities for direct communication with peers and professional personnel in the child’s language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the child’s language and communication mode; and (v) consider whether the child needs assistive technology devices and services. [IDEA § 1414(d)(3)(B)]
Parents and IEP teams assign or hire an interpreter based on the child’s mode of communication. With respect to children who are d/Deaf or hard of hearing (D/HOH), this includes oral transliteration; cued language transliteration; sign language interpreting, and interpreting, and transcription services, such as Communication Access Realtime Translation (CART), C-Print, and TypeWell [IDEA, 34 C.F.R. § 300.34(c)(4)].
Services for multilingual learners must take the language(s) of the home into consideration for both assessment and intervention. For children who receive services with an IEP under Part B (ages 3–21 years):
When evaluating English language learner (ELL) students, it is important for speech-language pathologists (SLPs) to carefully review the child’s language history to determine the language of assessment. If it is determined that the child should be evaluated in a language other than English, the SLP must use all available resources, including interpreters, when necessary, to appropriately evaluate the child. (ASHA, n.d.-a, para. 4)
See ASHA’s resource on IDEA Part B: Culturally and Linguistically Diverse Students and Practice Portal page on Multilingual Service Delivery in Audiology and Speech-Language Pathology.
Part C
For children who receive services with an individualized family service plan under Part C (from birth to 2 years of age):
Sections 303.321(a)(5) and 303.321(a)(6) state that all evaluations and assessments of a child must be conducted in the native language of the child, in accordance with the definition of native language in §303.25, unless clearly not feasible to do so. While the phrase “unless clearly not feasible to do so” was added to acknowledge that there may be instances where conducting an assessment in the child’s native language is not possible, the U.S. Department of Education, in the discussion section of the final regulations, clarifies that best efforts should be put forth to locate an on-site or telephonic interpreter when needed. (ASHA, n.d.-b, para. 4)
“Native language,” as defined in Section 303.25(a)(1) of IDEA, means “the language normally used by that individual, or in the case of a child, the language normally used by the parents of the child.” See ASHA’s resource on IDEA Part C: Cultural and Linguistic Diversity.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides national standards to protect the privacy of protected health information. Some regulations include provisions related to service providers working with language assistance providers.
HIPAA allows covered health care providers to share a patient’s health information with an interpreter without the patient’s written authorization under the following circumstances:
Title VI of the Civil Rights Act of 1964 prohibits discrimination based on national origin, which the Supreme Court, the Department of Health and Human Services, and other federal agencies have interpreted to include language. Any organization receiving federal funding—such as Medicaid and Medicare—must still provide meaningful language access to individuals with limited English proficiency (LEP).
Section 1557 of the Affordable Care Act (2024) prohibits discrimination in covered health entities or activities. “Covered health entities” (the term used in this legislation) may include the following:
Health entities must also take reasonable steps to provide meaningful access to people who use languages besides spoken English. Covered health programs or activities are also required to post taglines in at least the top 15 languages in their state. Taglines are brief messages in documents and websites that explain how a person can obtain a translation of the document or request an interpreter to explain the document for them in their heritage language(s).
Section 504 of the Rehabilitation Act of 1973 protects people with disabilities, including people who are D/HOH, from discrimination in any program or activity receiving federal funding. Section 504 ensures that people with disabilities have equal opportunity, with reasonable accommodations, to access and participate in education, employment, and health care. Section 504 protections include effective communications (e.g., on-site or remote interpretation services, screen reader software), telecommunications, and signage (45 C.F.R. § 84).
On March 1, 2025, the Trump administration issued an executive order “Designating English as the Official Language of The United States.” Although this executive order indicates a shift in stance and revokes the Clinton-era Executive Order 13166 [PDF], existing language protections under federal law still stand. This executive order does not undo existing language access obligations tied to federal funding (González-Cestari, 2025). The executive order states that “nothing in this order, however, requires or directs any change in the services provided by any agency” [Section 3(b).
The Joint Commission accredits and certifies health care organizations and programs in the United States. Patient-centered communication standards for hospitals are published in the Comprehensive Accreditation Manual for Hospitals (The Joint Commission, n.d.). The standards address issues such as qualifications for language interpreters and translators, identifying and addressing patient communication needs, collecting patient race and ethnicity data, patient access to a support individual, and nondiscrimination in care.
The National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care (Office of Minority Health, n.d.) aim to advance equitable and quality health care and help eliminate health care disparities by providing a model for professionals and health care organizations to implement culturally and linguistically appropriate services (CLAS). Although these guidelines are not federal law, they are recommended by the U.S. Department of Health and Human Services Office of Minority Health. The CLAS standards for communication and language assistance are as follows (Office of Minority Health, n.d.):
Legal and ethical considerations are foundational to appropriate services. There may be times when services meet legal (local, state, federal) regulations/requirements but do not meet the fundamentals of ethical conduct. Codes of ethics or professional conduct are principles designed to help professionals conduct business honestly and with integrity. It is critical that clinicians have a working knowledge of both legal and professional ethics standards (i.e., practicing antidiscrimination in the provision of services, ensuring patient privacy)—as they pertain to working with interpreters, transliterators, and translators—to ensure appropriate clinical interactions.
The ASHA Code of Ethics (ASHA, 2023b) provides the fundamentals of ethical professional conduct. Principles of Ethics and Rules of Ethics are specific statements of minimally acceptable—as well as unacceptable—professional conduct and apply to all individuals who are ASHA members and/or certificate holders or who are applicants for certification.
The clinician is responsible for understanding cultural and linguistic variables that may impact service delivery. For further information, please see ASHA’s Practice Portal page on Cultural Responsiveness.
Although providing cross-linguistic services may require the assistance of trained interpreters or multilingual professionals, it is the responsibility of the clinician to understand the influence of cultural and linguistic variables on communication, such as second-language acquisition, dialectal differences, interference/transfer, and translanguaging. Ultimately, the clinician is responsible for the appropriate diagnosis and treatment/management of communication disorders within and across world languages and dialects as well as swallowing and balance disorders.
Periodically, the Board of Ethics develops Issues in Ethics statements when further clarification and guidance are needed to assist in ethical service delivery. The Issues in Ethics statement, Cultural and Linguistic Competence (ASHA, 2017), specifically addresses working with interpreters for the provision of services. ASHA’s Prohibitions Against Discrimination Under ASHA Code of Ethics and Enforcement by the Board of Ethics emphasizes the importance of ethical service delivery in communication sciences and disorders or in the professions of audiology and speech-language pathology.
The responsibility of language access planning varies based on a clinician’s setting. For school settings, the school district provides language access to students and their families regardless of whether they are in general or special education. If an SLP is a case manager, then they have a responsibility to follow the school district’s language access plan. Below are the considerations for language access planning for health care providers and agencies, including private practice settings, based on the provided resources:
Visit the U.S. Department of Health and Human Services’ Limited English Proficiency (LEP) Resources for Effective Communication and Limited English Proficiency (LEP) web pages for more information.
For more information, see the U.S. Department of Health and Human Services’ 2024 U.S. Department of HHS Language Access Plan [PDF].
Read more in Centers for Medicare & Medicaid Services’ Guide to Developing a Language Access Plan [PDF].
Find training examples at Language Access Fundamentals (Welcoming America, 2024) and Communicating With Multilingual Populations: Language Access Toolkit [PDF] (Global Wordsmiths, n.d.).
For more information, see Conducting Public Forums and Listening Sessions (Head Start, 2025).
For more information, see Medicaid and CHIP Reimbursement Models for Language Services: 2024 Update (Youdelman, 2024) and Federal Laws and Policies to Ensure Access to Health Care Services for People With Limited English Proficiency [PDF] (National Health Law Program, 2018).
By addressing these components of language access planning, service providers and agencies can ensure they meet legal requirements and provide equitable access to services for multilingual individuals.
For more information about clinical practice with a person who uses a language different from the clinician’s, visit ASHA’s Practice Portal page on Multilingual Service Delivery in Audiology and Speech-Language Pathology.
The clinician should consult the patient and care partner to determine the mode of communication or accommodation that best suits each clinical interaction. This choice may vary depending on the type of clinical encounter (i.e., meeting, counseling, assessment, intervention) and the setting protocols. The patient’s equitable access to services includes the following:
During service provision, clinical encounters with the patient and care partner may require different types of interpreting, transliteration, and translation services.
Interpreting can be either simultaneous or consecutive. These two types of interpreting are described below.
Simultaneous interpreting—the interpreter communicates what a speaker or signer is saying into another language while they (the speaker or signer) continue to speak or sign. This method helps meetings run smoothly without interruptions, especially in clinical settings or when most participants speak the same language. Simultaneous interpreting is used more with signed languages than with spoken languages because when multiple people in a group are speaking and interpreting at the same time, it can cause auditory interference for the listener (Langdon & Saenz, 2016).
Consecutive interpreting—the interpreter (a) waits for the speaker to finish a section of speech and then (b) communicates the message during a pause. The interpreter breaks the message into manageable segments to ensure that the listener can clearly understand the message in the target language. Consecutive interpreting is used more during assessments and interventions for spoken language. Both spoken- and sign-language interpreters may use this method when a patient provides a lot of information at once to ensure full understanding and accurate translation. It is also preferred for patients with cognitive challenges (Langdon, 2002).
Interpreters, on site or by telephone, may switch between consecutive and simultaneous interpreting based on the needs of the clinical interaction and the communication goals.
The three types of transliteration—oral, cued speech, and sign—are described below.
Oral transliteration—the transliterator mouths words clearly so that people who are D/HOH and skilled in speechreading can understand what is being said by watching the transliterator’s face, gestures, body language, and lips. Oral transliterators may choose to rephrase a message with words that are more visible on the lips when possible. They may also “voice” for individuals who are D/HOH (Registry of Interpreters for the Deaf, 2007).
Cued speech transliteration—the transliterator uses handshapes and movements in different locations near the mouth to depict sounds used in spoken language. The clinician generally uses cued speech to support speechreading by providing a visual representation for the sounds in a language. However, it is not a form of sign language (National Cued Speech Association, 2006).
Sign transliteration—the transliterator uses signs in the word order of the target spoken language (e.g., signed English) to convey the spoken message for people who are D/HOH who do not use a formal sign language (e.g., American Sign Language).
Not all spoken and manually coded languages, including American Sign Language, have a written form. The various types of translations are discussed below.
Machine translation—text-based automated translation that provides instant translations between languages without the assistance of, or review by, a qualified human translator (Section 1557 of the Affordable Care Act [2024]). According to Section 1557 of the Affordable Care Act, a qualified human translator must review the machine translations in any of the following situations (89 F.R. 37522):
Prepared translation—the translator prepares the written version of a document, such as a letter or report, in advance. Enough time must be allowed based on task complexity. For instance, an appointment reminder may not take long, but a short assessment piece could take much longer, depending on the focus of the assessment. The clinician should be available to answer the translator’s questions about the materials. Prepared translation may be the most common form of translation in clinical settings.
Prepared translation can be used to prepare instructions, assessments, treatment, and educational materials in advance. Prepared translation may also be necessary when the clinician is providing written reports or documentation of assessments and progress, such as IEPs or discharge reports.
Sight translation—the translator provides a spoken or signed translation while reading a written document in a clinical encounter reserved for more immediate and spontaneous needs. This approach is not a reasonable option for informed consent, other legal documents, or formal assessment measures. The clinician may use sight translation when they decide that certain materials may be more appropriate for a clinical encounter than other types of translations that they had previously prepared (Langdon & Saenz, 2016). See the Impromptu Translation section of this document for more information.
Interpreters, transliterators, and translators may serve in the role of a cultural broker (Torres et al., 2015) or a linguistic broker (Orellana et al., 2014). Audiologists, SLPs, audiology assistants, and speech-language pathology assistants can also serve as cultural or linguistic brokers if they have relevant knowledge and experience with the patient and care partner’s cultural and linguistic background. Visit ASHA’s Practice Portal page on Multilingual Service Providers for more information.
Cultural broker—a person who knows about the setting’s culture as well as the patient’s culture and/or speech-language community. The cultural broker is someone who can build trust between individuals or groups of different cultural systems. The broker passes cultural and community-related information between the patient and the clinician to help people effectively navigate health, education, or human services systems (Pang et al., 2019).
Linguistic broker—a person who knows about the setting’s language and the patient’s language community or communication environment. A linguistic broker can provide valuable information about language and sociolinguistic norms.
A cultural or linguistic broker can provide the following skills and knowledge:
When collaborating with language assistance providers, audiologists and SLPs remain responsible for planning the session, selecting culturally and linguistically relevant materials, and appropriately administering assessment and treatment. The interpreter or transliterator assists the clinician in gathering the appropriate data and provides language support for services appropriate to the patient. For additional roles and responsibilities for multilingual service delivery, visit ASHA’s Practice Portal page on Multilingual Service Delivery in Audiology and Speech-Language Pathology.
Appropriate roles and responsibilities of audiologists, SLPs, and assistants (as their respective scope of practice allows) when collaborating with an interpreter, a transliterator, or a translator include the following:
The ASHA Code of Ethics (Principle I, Rules A, B, and C; Principle II) provides the baseline for the quality of services that the clinician is expected to provide. These expectations are as follows:
In addition to federal requirements for education, training, certification, and/or licensure of language assistance providers, state and employer policies may vary. Some state laws and regulations impose additional standards and requirements for working in specialized settings (e.g., legal, medical, and educational), particularly when serving individuals who are D/HOH. See State-by-State Regulations for Interpreters and Transliterators for requirements for interpreters and transliterators for individuals who are D/HOH.
Employers such as school districts, courts, and health care systems may also have interpreting aptitude tests, performance assessments, or boards that evaluate interpreters before they are hired. These employers may also require credentialing from a state or national organization. A growing number of state and national associations have professional standards and certification for trained interpreters. Trained and/or certified professionals have codes of ethics within their professions that they are expected to maintain. See the Registry of Interpreters for the Deaf, National Council on Interpreting in Health Care [PDF], American Translators Association [PDF], and National Association of Interpreters in Education.
Language assistance providers can effectively bridge communication gaps and provide accurate, culturally appropriate translations with the following knowledge and skills (California Speech-Language-Hearing Association, 2017):
Most of the time, organizations may have established relationships—such as a referral list—that specify which companies or people can serve as an interpreter, a transliterator, or a translator. A clinician may or may not have the opportunity to provide input on the selection for the initial meeting with the patient or care partner. However, to the maximum extent possible, employers are encouraged to use the same interpreter, transliterator, or translator for multiple encounters, so that the clinician may establish a familiar relationship and provide knowledge of the work process.
Individuals who serve as interpreters, transliterators, or translators include
The list above, arranged in approximate order of preference, does not account for the unique variables inherent in clinical interactions. Interpreters have unique skill sets and expertise. Clinicians collaborate with them whenever possible, as appropriate, in multilingual service delivery. Multilingual audiology and speech-language pathology assistants are not interpreters. Audiology and speech-language pathology assistants may be able to interpret to meet an unanticipated need.
Consult ASHA’s Practice Portal pages on Multilingual Service Providers, Audiology Assistants, and Speech-Language Pathology Assistants.
Multilingual assistants and professional staff must consider their linguistic proficiency in the languages being used, including (a) their proficiency in the local dialect of the language(s) being used by the patient and their care partner and (b) their own knowledge and skills for interpreting, transliterating, or translating. Dialectal mismatches—such as a Spanish-speaking individual from Mexico interpreting for a Spanish-speaking patient from Spain or Argentina—may result in inaccurate interpretations, inaccurate translations, and/or cultural misunderstandings (Ostergren, 2014).
The need for an interpreter, a transliterator, or a translator may influence a clinician’s ability to diagnose, treat, and seek reimbursement for services. Therefore, it is best to work with trained interpreters, transliterators, and translators when possible. On limited occasions, there may be reasons why a family member or friend serves as an interpreter, a transliterator, or a translator—either due to patient preference or because all other efforts to locate an appropriate language assistance provider have been exhausted. A facility may be unable to locate a person who is able to meet the linguistic needs of the patient. For example, family or community members may be the only source of information for a less commonly known language, such as Pirahã, an Amazonian language for which access to language assistance providers is scarce.
Family or friends acting as interpreters, transliterators, or translators may present potential conflicts (Iqbal & Crafter, 2023). The reliability of language assistance may be compromised because of potential conflicts of interest and limited training of the family member or friend. It is important to be mindful of risks in high-stakes situations, such as mediation, evaluations, or situations where cognitive capacity might be in question.
When considering working with family members or friends in this role, the clinician reviews the following factors:
There are legal and ethical considerations for asking family members or friends to serve as interpreters, transliterators, or translators. See the State and Federal Legislation section and the Ethics section of this document for more information.
The clinician and the interpreter or transliterator collaborate using the briefing–interaction–debriefing framework (Langdon, 2002). Successful collaboration is inherent to successful service delivery (Alani et al., 2024) and is based on a shared understanding of the goals established by the clinician (Gardner & Love, 2021). This can be achieved by properly preparing the interpreter or transliterator for what to expect from the assessment or treatment session. The audiologist or SLP is responsible for the assessment or treatment session and is actively engaged in the encounter with the patient and interpreter. After the assessment or treatment session, the clinician and the interpreter or transliterator should discuss how the session went to be sure that no issues arose that need to be discussed (Langdon, 2002; National Council on Interpreting in Health Care, 2024).
Collaborating with an interpreter or a transliterator who is untrained in the communication sciences and disorders setting may influence a clinician’s ability to diagnose, treat, and seek reimbursement for services. Untrained interpreters or transliterators may unintentionally misrepresent a meaning when converting messages into another language and/or reporting patient responses, particularly if they are unaware of the purpose of the exercise or assessment. Untrained interpreters and transliterators may also influence patient responses or understanding of clinician questions. In some cases, seemingly small errors can change the meaning of a question or response and can have drastic effects on outcomes. For this reason, it is best to work with a trained interpreter or transliterator when possible. Because of the specific nature of the fields, a clinician will need to provide training prior to the session to ensure the best possible outcomes during clinical sessions and should periodically check in to assist in the effective delivery of services (Langdon & Saenz, 2016).
Reports and submissions for insurance claims note when a clinician works with language assistance providers and the impact of that collaboration on assessment and intervention findings. Documentation should also indicate the use of translated materials. This documentation provides an accurate record of clinical interaction and a legal record of the services provided. It also provides evidence of ethical conduct, consistent with Principle of Ethics I, Rules of Ethics B, C, and Q (ASHA, 2023b). See ASHA’s Practice Portal pages on Documentation of Audiology Services, Documentation in Health Care, and Documentation in Schools.
See also Perspectives of the ASHA Special Interest Groups articles—Guidance on the Effective Collaboration With Interpreters and Translators in Speech-Language Pathology (Alani et al., 2024) and Working With Interpreters to Support Students Who Are English Language Learners (Langdon & Saenz, 2016)—for additional information on how to debrief with an interpreter before and after your session.
Clinicians meet with the interpreter or transliterator in advance to allow for adequate preparation time, when possible. Clinicians take the following actions before the session to ensure a successful collaboration (Langdon, 2002):
Setting Expectations With the Interpreter and Transliterator
Reviewing Assessment and/or Treatment Procedures
Clinicians take the following actions during the session:
Introduction and Roles
Session Management
Communication Guidance
Cultural and Linguistic Considerations
The clinician takes the following actions after the session (Langdon, 2002; Langdon & Saenz, 2016):
For more details about assessment and treatment considerations for multilingual populations, visit ASHA’s Practice Portal page on Multilingual Service Delivery in Audiology and Speech-Language Pathology.
Special considerations for effective collaboration with translators are as follows:
Dialectal differences may influence translation. To the maximum extent feasible, ensure that documents are written in a way that is the most universally understood by speakers of different dialects of a written language.
All vital written documentation provided to the care partner is translated into the patient’s and care partner’s preferred language.
Provide all legal documents and highly relevant materials to the translator ahead of time. In a research setting, informed consent is presented to each human subject “in language understandable to the subject” (Federal Policy for the Protection of Human Subjects, 2001). Informed consent is documented in writing in most situations.
Clinicians provide sufficient time for the translator to become familiar with these documents. Not all spoken or signed languages have written forms of communication.
Prepared or on-site translation of formal assessments that have been standardized on English-speaking populations may provide the opportunity to gather information in a structured manner. However, the clinician must critically evaluate the validity of the translated materials. For example, speech sound elicitation materials may not elicit the same sounds, and allophonic variation will differ across languages. For example, subject omission is acceptable in Spanish but not English, so in a sentence repetition task, take great care in how the data are used. Written permission is to be obtained from the test publisher before test materials can be translated either for a clinician’s individual use or for dissemination of the translated version of the test for use on a wider scale (i.e., clinical program, district, or research group). In the circumstances above, it is not appropriate to report standard scores.
Clinicians are cautious about using technology for on-site translation. Software programs frequently look for verbatim substitutions and do not offer professional, reliable results. Interpreting and translating may not always be a word-for-word substitution but, instead, may require more or fewer words to communicate an intended message as well as complete syntactic restructuring of sentences or even full paragraphs to maintain cohesion and coherence. See the definition of machine translation in the Types of Translation section of this document.
Patients are not expected to pay out of pocket for language assistance services to ensure access to care. Several laws and regulations mandate that organizations receiving public funding, such as Medicaid/Medicare or IDEA funding, provide and arrange for meaningful language access. Those organizations are responsible for the funding of a language assistance provider, as needed.
Agencies, administrators, and service providers can leverage the following funding sources and strategies to pay for language assistance services and ensure that all individuals, regardless of language ability, have access to essential services. Here are some key methods:
Clarify the party responsible for payment of interpreter, transliterator, or translator services when providing contracted services. For example, the facility may be responsible for providing appropriate accommodations for language assistance services, or the clinician may need to list language assistance services as a line item in the clinician’s services.
Additional considerations for contracting interpreters, transliterators, or translators are as follows:
Technology offers opportunities for individuals to access interpretating, transliteration, and translation services. The list below is not exhaustive:
Technology may be used to facilitate carryover and recall of strategies and techniques. Smartphones provide an opportunity to record spoken language and video signed languages to allow patients and care partners to revisit clinical recommendations.
At times, patients and/or care partners may refuse the assistance of an interpreter or a transliterator. Clinicians consult with patients and caregivers/care partners on the value of working with the interpreter or transliterator so that (a) the patient and the care partner can fully participate in health services and care and (b) the clinician can obtain the most accurate data. If language assistance services are refused, the clinician documents the following:
A signed release statement should be collected in cases where such services are declined, which includes the reason for the refusal. The service provider informs the patient and care partner of the benefits of language assistance services and the potential adverse consequences of not having such services. The service provider also documents the above conversation.
This list of resources is not exhaustive. The inclusion of any specific resource does not imply endorsement from ASHA.
Alani, S., Boyer, V. E., Harten, A. C., Franca, M. C., Stierwalt, J. A. G., & Pegoraro-Krook, M. I. (2024). Guidance on the effective collaboration with interpreters and translators in speech-language pathology. Perspectives of the ASHA Special Interest Groups, 9(3), 795–803. https://doi.org/10.1044/2024_PERSP-23-00143
Al Shamsi, H., Almutairi, A. G., Al Mashrafi, S., & Al Kalbani, T. (2020). Implications of language barriers for healthcare: A systematic review. Oman Medical Journal, 35(2), Article e122. https://doi.org/10.5001/omj.2020.40
American Speech-Language-Hearing Association. (n.d.-a). IDEA Part B: Culturally and linguistically diverse students. https://www.asha.org/advocacy/idea/idea-part-b-issue-brief-culturally-and-linguistically-diverse-students/
American Speech-Language-Hearing Association. (n.d.-b). IDEA Part C: Cultural and linguistic diversity. https://www.asha.org/advocacy/idea/idea-part-c-issue-brief-cultural-and-linguistic-diversity/
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Content for ASHA’s Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Collaborating With Interpreters, Transliterators, and Translators page:
Primary Version
Subsequent Versions
ASHA seeks input from subject matter experts representing differing perspectives and backgrounds. At times, a subject matter expert may request to have their name removed from our acknowledgment. We continue to appreciate their work.
The recommended citation for this Practice Portal page is:
American Speech-Language-Hearing Association. (n.d.). Collaborating with interpreters, transliterators, and translators [Practice portal]. https://www.asha.org/practice-portal/professional-issues/collaborating-with-interpreters/
Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.