In-Person Interpreter or VRI for Deaf Students in the Hospital

School Nurses Advocate, Educate & Nurture Confidence for the Future

Timothy Vander Ploeg, RN, RN-BC, BSN


  • ADA – focus on “effective communication” for deaf & hard of hearing (HoH) people.
  • In-person American Sign Language (ASL) interpreters are the most appropriate interpreters for school aged deaf children.
  • Hospitals often have policies and procedures for deaf adult patients that are not effective with deaf children.
  • Not all hospital staff know the use of a professional ASL interpreter (or reasonable alternative) is required by law (ADA).
  • Ineffective communication can lead to diagnosis and treatment errors.


  • Educate hospitals, students and families.
  • Ensure that students get effective communication during their hospital visits.
  • Nurture students’ confidence when going to the doctor.
  • Encourage full participation in healthcare for students that continues into adulthood.

In-Person Interpreter vs. VRI

In-Person Interpreter

  • Uses local signs that students will understand.
  • Can use whole body to communicate and see patient’s whole body to understand and utilize nuanced communication.
  • Trained for medical interpreting & can manipulate models and draw pictures to explain medical concepts.
  • Are more appropriate for children.

Video Remote Interpreting (VRI)

  • Acceptable in an emergency if no in-person interpreter available yet.
  • Can bridge the time from when arrived to when an in-person interpreter is available.
  • If an in-person interpreter gives a smaller hospital/clinic an “undue fiscal burden”, VRI may be appropriate.
  • If hospital hangs up on VRI and calls back later the student may not get the same interpreter (loss of continuity of care).

Ideal Use of In-Person & Video Remote Interpreters

Reasons to Nurture Positive Medical Experience

  • Everyone needs to be comfortable going to MD with health concerns.
  • Lifelong ownership & participation in healthcare is important to good health.
  • To give confidence that their MD is giving them proper care.
  • If they are confident, they can share confidence and knowledge with others.

Being an Advocate

  • Educate students & families of legal rights to effective communication.
  • Family members are not obligated to interpret for children, and, even worse, the child may be uncomfortable sharing sensitive information & skew the information given to the doctor.
  • Encourage students & families to request an in-person interpreter when setting up appointments.
  • Contact Hospitals to see what they will do if you need to send a child to the ED (e.g. call ahead so they can get an in-person interpreter or prepare VRI).
  • Find out who needs to be contacted at the medical facility to get the best interpretive services.
  • Follow up with students and families to see if the process worked and if an interpreter was present.

Interesting Facts

Number of Deaf and Hard of Hearing People

  • 9-22 out of 1,000 people are deaf or are severely hard of hearing.
  • 90% of deaf children are born to adults who are hearing.
  • Over 75% of deaf students are mainstreamed in public schools
  • ~108 Schools and Programs for Deaf & Hard of Hearing in the US

History of Language

  • ASL is a language with 200 years of history in the US & is not a direct translation of English.
  • The Americans with Disabilities Act (ADA, 7/26/1990) gives rights for “effective communication” & qualified interpreters.
  • Different students may use different sign languages (PSE, SEE, ASL or Cued Speech) & need an interpreter with matching skills.
  • English is often a 2nd language for deaf students & they may not have proficiency so writing notes is not effective communication.
  • Lip reading is not very accurate (30-45% at best).

Deaf Adults

  • Ineffective communication gives an experience of fear, mistrust and frustration in medical situations and may lead to avoiding medical care even with serious symptoms which can lead to poor outcomes.
  • Experience embarrassment when being followed along with a VRI.