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Effective TB Interviewing for Contact Investigation: Self-Study Modules

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Case Presentations

The following case presentations demonstrate concepts from this module. You may review them with your supervisor if you have questions.

Case 1

Part 1 – Tony is a 56-year-old homeless man. He was diagnosed with TB, and you are interviewing him in the hospital. He is very talkative and friendly. You have completed your introduction and provided TB education. However, as you move through the interview, Tony moves off topic frequently. He talks about his fear of being “kicked out” of the shelter he lives in and his concern about not getting his monthly disability check. You haven’t been able to obtain much information regarding the contact investigation from him.

How can you accomplish the interview objectives when the interview is taking a different direction as it progresses?

Explanation: While it is important to accomplish certain objectives during an interview, these objectives may not be of importance to Tony if he has other pressing concerns. By using the communication methods of reflection and paraphrasing, you should be able to uncover and validate Tony’s primary life concerns at the same time. You can say, “It sounds like you are very concerned about where you will be living,” and “You seem worried about receiving your money.” By doing this, you are communicating that you are listening and are concerned for Tony’s well being.

Part 2 – Upon hearing you acknowledge his concerns, Tony immediately asks if you can help him.

How should you now proceed with moving the interview in a useful direction?

Explanation: The interview objectives will not be accomplished unless Tony is reassured that his other concerns will be addressed. Acknowledging his concerns is the first step. You can talk to Tony about referring him to a case manager or others within the health department who can work with him on housing and financial issues. Mentioning this possible resolution may not prompt Tony to answer all of your questions immediately, but it may ease his worries so that you can move on with the interview.

Part 3 – Since you have eased some of Tony’s concerns, he seems eager to proceed with answering the rest of your questions. You begin to ask Tony open-ended questions about where and with whom he spends time. As Tony shares information with you, you realize that his answers are not precise. For example, if you ask him what he does each day, he gives a variety of answers. He also names many contacts that you are not sure are truly priority contacts.

How can you ask Tony questions in such a way that you will obtain more specific information about places he frequents and individuals with whom he spends prolonged periods of time?

Explanation: A combination of open-ended and focused questions would be appropriate in this situation. While you have assessed that Tony spends time in various places, you are mostly concerned with where he regularly spends time. You can ask him where he spends time, but provide a specific time frame. Regarding with whom he spends his time, a time frame is also appropriate to determine if these individuals are priority contacts. Since various methods for identifying contacts are required, you should ask for specific pieces of information including physical descriptions and nicknames. These can be posed as closed-ended questions.

Part 4 – As you progress further through the contact elicitation, Tony’s answers become shorter and less detailed. His eye contact begins to falter.

What seems to be occurring based on what has transpired so far during the interview and your assessment of Tony’s body language? What can be done to resolve this situation?

Explanation: Based on what you know and are observing, Tony appears to be growing tired and is therefore unable to concentrate on the interview process. Tony is a newly diagnosed TB patient who has participated in a lengthy interview thus far, and you must be sensitive to the fatigue that may occur. At this point, you can tell Tony, “It appears as though you are getting tired. We can continue this interview at a later time when you may be more up to talking.” You should end the interview on a positive note, thanking Tony for his time and shaking his hand.

Case 2

Part 1 – May Lee is a 67-year-old woman from China who is a TB suspect and requires a TB interview. You looked at her medical record, in which you found out that you will need an interpreter to complete the interview in her home. You talk this over with a colleague, who says that he is proficient in Mandarin and would be happy to attend the interview as an interpreter.

Should you take up your colleague’s offer to interpret?

Explanation: While it is tempting to bring along a person you know and are comfortable with, another healthcare worker is not always an appropriate choice for interpretation. An interpreter should be trained or certified in medical interpretation.

Part 2 – You thank your colleague for his offer to interpret, but tell him that you will try to locate a medical interpreter through your health department listings. You tell your colleague that if you cannot locate an interpreter, you will have him come along. However, you are able to get an interpreter and set up a time for the interview at May Lee’s home. You plan to pick the interpreter up in your car so you can both arrive together.

In your health department, the general practice is not to make appointments with patients for TB interviews, but rather to simply arrive unannounced at their homes. However, since you need to ensure that the patient is home and schedule an interpreter to come with you, you ask your Mandarin-speaking coworker to call the patient to make sure she will be home when you are scheduled to arrive.

What should you do on the day of the interview, just prior to entering the patient’s home?

Explanation: While in the car with the interpreter, you should set up some ground rules. These rules should address keeping all communications confidential, interpreting all communications precisely without editing, adding, or deleting information, and stopping the interaction if clarification is needed or if more time is required to complete the interpretation.

Part 3 – The interpreter agrees with your ground rules. You then knock on the patient’s door and enter her home. You explain to her that the interview will be through a trained interpreter and that all communications will be confidential. You also let her know that the interpreter will be stating all communications exactly as they occur in both English and Mandarin.

As the discussion progresses, you notice that the interpreter is struggling a bit with the discussion and seems to be slowing down. The interpreter tells you that though he is trained in Mandarin, he has not worked with the dialect for a while. Therefore, it is taking him a little longer than expected to interpret.

What can you do to ease the communication?

Explanation: In addition to slowing your rate of speech and speaking in shorter sentences, you can stop the conversation occasionally to ask the interpreter if the process is progressing well or if he needs a break or assistance. The interpreter may be tired after a while and in need of a short break.

Part 4 – As the conversation proceeds, you notice the interpreter’s sentences seem to be getting shorter than what they had been thus far. He is also not interpreting after each pause in your conversation, but does so after you provide several opportunities.

How do you address this apparent communication gap with the interpreter?

Explanation: The interpreter may be paraphrasing the conversation. While you do not know Mandarin to make a definite determination about this, the fact that the pattern of the interpreter’s speech has changed is a good indicator. You should therefore stop the interview and tell the interpreter that you sense that the entire conversation may not be interpreted exactly as you indicated in your ground rules. Again, ask if the interpreter needs a break or assistance, and how you can make this an easier process.

 
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