Using an Interpreter & Developments in Translating the ACL

What are the guidelines when using a translator/interpreter for the ACLS/LACLS screening tool?

1. Ask the interpreter to translate in the first person (e.g., “I” instead of “she says”). This keeps communication direct and reduces confusion.

2. Be aware of the interpreter giving hints unintentionally when translating. They should translate only what you say without additional explanations. 

3. Explain beforehand what you need and ask them to interpret the client's questions and translate your responses. Tell them it is a standardised assessment: “ Translations should maintain the intent of the instruction without simplifying or adding cues that could alter the task demands.”

4. Ask the interpreter to repeat key instructions back to you in English. This ensures:

   • No extra cues were added

   • The structure of the instruction is preserved.

   5. When demonstrating the task - Translate one sentence/direction at a time and demonstrate as the translator speaks.

5. Give the translator some encouragement phrases before you start and ask them to have a consistent translation ready for when they are required. For example: What do you think? / Try your best. /  Have a go. / I appreciate how hard you are trying. / Does yours look like mine?

6. Often I just use the interpreter for the first part of the assessment when engaging the client, getting consent and exploring their occupational performance history. It can be helpful to have the interpreter nearby for when you need them but many people speak enough English for you to do the screen as it is not language based.

   At Levels 3 and 4, clients rely primarily on visual and motor cues rather than verbal instruction. Language is most effective when limited to nouns (objects) and verbs (actions) at Level 3 with the addition of adjectives and adverbs (describing words) at Level 4. At Level 5, clients begin to process relationships between actions, which is reflected in their ability to understand conjunctive language (e.g., and, but, then). These structures require linking steps and understanding sequence and consequence. For example:

   • “Don’t pull the lace tight but leave a loop…” → conjunctive (links two actions)

     ".....then by pulling…” → conjunctive adverb (sequence)

7. Document interpreter involvement and any factors that may influence standardisation.

8. If you speak a language other than English, you can translate the assessment bearing the above in mind.

9. The manual does not provide guidance on translation.

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Can the ACL be used cross-culturally with non-English speaking clients?

Question:

I am curious to know whether there has been any development of ACLS manual/instruction in other languages. There may be Japanese and Spanish versions? How about Chinese and Arabic? I guess it’s not a priority in research as the instruction is not presented for participants to read. Only therapists speaking the language or using the ACLS in these countries may find it helpful. Here in Australia, we probably just use interpreters for CALD consumers.

Any thoughts and comments?  

Response:

Translations seem to be driven by clinical need. They have large Spanish speaking populations in the USA. The model is used extensively in Japan and Korea. I am not sure why the Cantonese translation was done without reference to the Allen Cognitive Group who have the copyright. The work was done by a Chinese therapist based in Hong Kong as part of a PhD. It is likely that other OTs have translated it unofficially. Lots of OTs translate it ”on the go”, or official translators are used. I do advise OTs to watch carefully as I have had translators give instructions or cues to people because they don’t understand the process of the assessment or what we are trying to achieve. I personally only use a translator when the person being assessed does not have any English. Basic conversational English is sufficient for the actual screen. You need a translator for the history taking, getting consent, establishing rapport etc. It is useful to have someone on standby to translate what the client says to you. This includes Auslan.

There are official translations in Spanish and Japanese. These are available through https://allencognitive.com/ There is also an unofficial Cantonese version that I am trying to access. Allen Cognitive Group and I are hoping the people who developed it will agree to making this an official version. I believe they use an unofficial Mandarin translation in China but I have been unable to find any information about this including the person who developed it. I believe someone is working on a translation into Korean but I am not sure where they are up to.

I would love an Arabic version and to talk to OTs who are native Arabic speakers. I wonder about the left to right process when doing a task, such as laying out clothes for dressing. Our culture is oriented to left to right and our writing goes from left to right. Arabic is right to left; Japanese and Chinese are read vertically. It pays to take some time to understand the cultural background of your client and adapt your communication, using clear, simple language and avoiding jargon.  Non-verbal cues and empathy also assist cross-cultural understanding with most language groups.