Guidelines for choosing an interpreter

The quality of in-person interpretive services available in different areas will vary depending on the sophistication of the local systems and the training available. Contracting with certified in-person interpreters is important if certification is available. Contracting with a vendor for video remote interpreter (VRI) and phone interpretation services is also recommended to ensure communication support when an in-person interpreter is unavailable. Phone and VRI can serve as the primary form of language support in many instances. VRI is also an acceptable alternative for a member using sign language unless the member or their companion indicates that their communication needs can only be supported by an in-person interpreter.

At a minimum, the interpreter should:

  • Be fluent in both languages in question
  • Be trained as an interpreter
  • Demonstrate professional medical interpreting experience
  • Not be a family member
  • Never be a child

Fluency and training

The interpreter should be fluent in both languages in question. Language screening is necessary to establish the degree of fluency.

The fact that a person is bilingual does not make them an interpreter; there are special skills involved in interpreting, especially in a healthcare setting. While training available for interpreters will vary by region, some professional training is absolutely necessary.

Untrained interpreters are at extremely high risk for adding material, omitting material, changing the message, giving opinions, and entering into long discussions with the patient or clinician from which the other is excluded.

Family relationships and children

Family members have a valid role in providing patient support; however, they are not appropriate interpreters. Family members often edit the patient's message heavily, add their own opinions, answer for the patient, and impede the development of the patient-provider relationship.

Patients may be reluctant to discuss certain problems in front of a family member and confidentiality becomes a concern. Family members are rarely trained interpreters and often are unfamiliar with medical terminology.

Additionally, the use of children to interpret creates an inversion of power relations in the family, where parents, not children, are normally in control. Lack of vocabulary in both languages is a serious problem. In addition, children are often traumatized if they are required to pass on bad news or if they are held responsible for negative outcomes.

Telephone Interpreter Services

Telephonic interpreting can often be an acceptable alternative to in-person interpreting and can also assist during the appointment-making process and other phone-based conversations. If a phone interpreter is used during the course of a visit, speakerphone is usually the most efficient method and should be used in a confidential area. Telephonic interpreting will typically not work for patients that use sign language for communication and VRI might be an acceptable alternative to an in-person interpreter.

Telecommunications Relay Services (TRS)

TRS is used with people who are hard of hearing, Deaf, Deaf-Blind, or have trouble speaking.

  • Teletypewriter (TTY): person uses text input device
  • Video relay services (VRS): person who uses ASL uses video equipment

How to use TRS

  1. Call patient: Most will have an established personal phone number that connects to a Communication Assistant (CA). If not, call Washington Relay 1-800-833-6384 or 711 and provide phone number.
  2. Speak through CA: Once connected, speak slowly and directly to the person you intended to call, NOT the CA. The CA is on the line to relay what is being said, not to be involved in the conversation. “Go ahead” indicates someone has finished speaking.

Video Remote Interpreter Services

Video Remote Interpreter (VRI) provides real-time, visual access to language services, including sign language and foreign, through a secure web-based camera. It can be used as a back-up tool for situations where face-to-face interpretation is necessary based on clinical and patient need and when an in-person interpreter isn't available.

While VRI can frequently serve as an alternative for members requiring sign language, consider the limitations of VRI for sign language and follow the request of the member if they indicate the need for an in-person interpreter for effective communication.

Some factors include the following considerations when determining whether VRI is appropriate and can be used as an alternative for an in-person interpreter.

The member or their companion is limited:

  • In his or her ability to see the video screen, either due to limited vision or the physical positioning of the member.
  • In his or her ability to move his or her head, hands, or arms.
  • There are multiple people in a room and the information exchanged is highly complex or fast-paced.
  • May move repeatedly to areas of the medical center that do not have a designated high-speed internet line.


Kaiser Permanente uses several vendors in our owned and operated facilities. If you do not already have your own contracts and agreements with a vendor for interpretive services, you may choose to establish one with one of these agencies.

Dynamic Language (Greater Seattle area)


Language Line (phone)


Spokane International Translation (Spokane)


Stratus (video)


TERP Sign Language Services (Greater Seattle area)


Hearing, Speech, and Deaf Center (Greater Seattle area)


A to Z Interpreting (Spokane)


Deaf-Blind Service Center (Greater Seattle area)


ASAP Translations (Spokane)


Content on this page is from the provider manual | Disclaimer