Child language brokering in mental health care settings
- Jennifer Drummond Johansen
- Jun 9
- 5 min read
The practice of utilizing children as language brokers in healthcare settings may offer immediate convenience for families and healthcare providers. However, it entails considerable risks and implications that can affect both the children's well-being and the accuracy of communication. This article explores some of the emotional, psychological, developmental, and ethical challenges associated with relying on children for language interpretation in mental health care settings.
Language barriers present a fundamental challenge for refugees and asylum seekers, undermining both the accessibility and quality of mental health services (1). Refugees suffering from trauma-related mental health issues often struggle with language acquisition due to impaired concentration, memory, and motivation—all crucial factors for learning a new language and engaging in integration activities (2, 3).
Child Language Brokering (CLB) refers to the practice where children facilitate communication between their non-native-speaking family members and individuals or institutions that speak the host country's language. This often occurs in contexts such as healthcare, education, and legal services. Children act as informal interpreters, helping their families navigate daily interactions and access services in a language they may not fully understand. Shannon (4) introduced the term to describe the complex social role that children fulfill when interpreting and translating for their families and it can be defined as those ‘interpreting and translation activities carried out by bilingual children who mediate linguistically and culturally in formal and informal contexts and domains for their family, friends as well as members of the linguistic community to which they belong’ (Antonini, 2015, p 48).
Despite broad consensus on the wide range of challenges, the use of children and adolescents as language mediators is often perceived as essential or unavoidable in health care settings in order to overcome language barriers in everyday life. Declining their assistance might lead to delays and potential conflict with parents who view the inclusion of family members as translators as beneficial, even in sensitive situations (6). Using professional interpreters can heighten parental concerns about confidentiality, especially in tight-knit communities. The patient may for example fear that interpreters could reveal personal information, including details about mental health issues, leading them to refuse the involvement of professional interpreters (7).
Emotional and psychological tress
One of the most immediate consequences of using child interpreters is the potential emotional and psychological stress it can impose on the child. Language brokering is an emotional complex activity in which both positive and negative feelings can co-exist (8). Positive feelings can be triggered by helping family members, however negative feelings can be evoked when child language brokers are disrupted from other activities, or when they experience language deficiency, or when they broker in sensitive contexts (9). Children might be exposed to sensitive or distressing information that is unsuitable for their age, including medical diagnoses, legal matters, or family disputes. The burden of managing communication in such crucial situations can cause considerable stress, as they might feel accountable for the outcomes. Furthermore, children may struggle with the power dynamics involved, feeling caught between their loyalty to their family and the demands of the situation. The pressure to accurately convey information while managing the emotional and relational dynamics can be overwhelming.
In some families, serving as an interpreter can be part of a broader scenario where children take on adult roles, carrying practical and emotional responsibilities beyond their maturity level. Through an interview with a young woman who was raised in a refugee family in Norway, I gained insight into how the mother's mental illness both impeded her ability to learn Norwegian and resulted in complete dependence on her children, despite having lived in Norway for 20 years.
“...Yes, I also wanted to mention that she does not know Norwegian. So, as a child it was me who would translate all letters, call different places and having that kind of role. Recently I read a letter describing illnesses and so on. Usually I would translate for her, but parts of this letter I did not translate. I thought it was too private.”
This example demonstrates that acting as translators often represents merely the surface of the broader responsibilities borne by these children. It also highlights how these roles present them with complex dilemmas that they find difficult to discuss with others (10). It also gives insight into how children can try to protect those for whom they broker, often navigating sophisticated social interactions and tactics (such as delay and selective modification) (11) and how their emotional involvement in the situation can affect the neutrality required for accurate interpretation and with this compromise the communication and the decisions based on it.
As discussed, using children as language brokers raises significant concerns. While child interpreters can provide necessary assistance in urgent situations, the practice carries significant risks and consequences that can impact both the child and the quality of interpretation. Emotional and psychological stress, role confusion, developmental impacts, accuracy and reliability issues, bias and partiality, and ethical and legal implications all highlight the drawbacks of using child interpreters. Interpreters perform an essential and multifaceted role in therapeutic settings, extending beyond mere linguistic translation. They facilitate patient access to care, enhance mutual understanding, and strengthen therapeutic alliances, while also increasing the cultural compatibility of services. The interpreter's background and ability to convey empathy can help establish trust and rapport, thereby enhancing the therapeutic relationship and improving health outcomes. Their role should be viewed as integral to achieving positive therapeutic results, rather than peripheral as often assumed (1).
Practical implications
We need to seek professional adult interpreters to both to ensure accurate, ethical, and effective communication, and to safeguarding the well-being of the children. In discussions with parents, it is crucial to emphasize the advantages of using professional interpreters to ensure accurate and confidential communication, especially within mental health settings. By addressing the challenges with Child Language Brokering, parents can better understand how professional interpretation supports their family's access to quality care and with this also empowering them to make informed decisions that protect their children from the pressures associated with language brokering. □
References
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Schick M, Zumwald A, Knöpfli B, Nickerson A, Bryant RA, Schnyder U, et al. Challenging future, challenging past: the relationship of social integration and psychological impairment in traumatized refugees. Eur J Psychotraumatol. 2016;7(1):28057-9.
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Shannon SM. English in the Barrio: The Quality of Contact among Immigrant Children. Hispanic Journal of Behavioral Sciences. 1990;12(3):256-76.
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Kletečka-Pulker M, Parrag S, Drožđek B, Wenzel T. Language Barriers and the Role of Interpreters: A Challenge in the Work with Migrants and Refugees. In: Wenzel T, Drožđek B, editors. An Uncertain Safety: Integrative Health Care for the 21st Century Refugees. Cham: Springer International Publishing; 2019. p. 345-61.
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