NC Council for the Deaf and the Hard of Hearing



NORTH CAROLINA COUNCIL FOR THE DEAF AND THE HARD OF HEARING

Quarterly Meeting Minutes

November 17, 2017

9:00 am – 3:00 pm

Division of Public Health, Six Forks Road, Raleigh, NC

Members Present:

Linda Amato

Julie Bishop

Craig Blevins

Mary Crump

Rep. Carla Cunningham

Kevin Earp

Rebecca Freeman

Ericka Gagnon

Pattie Griffin

Meredith Kaplan

Kerry Langhorne

Kunal Mitral, M.D.

Betsy Moore

Denise Nelson

Claudia Pagliaro, Ph.D.

David Rosenthal

Deborah Stroud

Brad Trotter

Senator Jeff Tarte

Tovah Wax

Ex Officio:

Jan Withers (Present)

DSB Liaison:

Kim Harrell (Present)

Members Absent:

Rep. Hugh Blackwell

Timothy Boyd

Bud Cayton

Kathryn Dowd, AuD

Lester Latkowski

Johanna Lynch

Senator Bill Rabon

NORTH CAROLINA COUNCIL FOR THE DEAF AND THE HARD OF HEARING

Quarterly Meeting Minutes

November 17, 2017

9:00 am – 3:00 pm

Joint Forces Headquarters, Raleigh, NC

Introductions, Announcements, Approve Minutes from August 11, 2017

August 11, 2017 minutes were approved.

None of the members acknowledged having a conflict of interest or appearance thereof on matters listed on this agenda

North Carolina Institute of Medicine

Adam Zolotor, M.D., President and CEO, North Carolina Institute of Medicine

I am Adam Zolotor, the president of the North Carolina Institute of Medicine. I’m here to tell you about what we do and how we may be able to work together and then talk a little about our meeting last Thursday Jan Withers referred to.

We are an entity established by the North Carolina General Assembly in 1983, and we are concerned with the health of the people of North Carolina. We establish task forces to work on health issues important to North Carolinians and we publish the North Carolina Medical Journal.

We study issues in task force format, based on the request of the North Carolina General Assembly, North Carolina State Agencies, often in partnership with the Department of Health and Human Services, but also other foundations, health professional organization and other nonprofit organization. Our task forces are typically 16 months, guided by co-chairs and steering committees. We usually have 30 to 60 members on the task force and the task forces represent a wide array of stakeholders invested in a particular issue. We typically have health care providers and provider organization, trade associations, advocacy organizations, consumers and consumer organizations, sometimes the community, insurers, depending on the issue.

We aim our recommendations at the end of a report toward policymakers. I often pick on my friends at the General Assembly, agencies within the Department of Health and Human Services, sometimes trade organizations, health care providers and educational institutions as well as local government.

We recently published the results of a task force, funded by Kate B. Reynolds Charitable Trust, on the substance abuse system for adolescents, older adults and other issues. Eighteen months ago, the Alzheimer's State Plan was published. This is an Alzheimer's State Plan called Dementia Capable North Carolina. This was co-chaired by Dr. Goldie Byrde. The Duke endowment was the largest funder but we had advocacy organization and smaller foundations making donations, too.

We had about 30 recommendations in 16 areas as specified in legislation for an Alzheimer’s State Plan. This report got a lot of traction in the first two sessions after the report was issued. Six bills were passed in response to this report during the short session last year, including four with funding, and we also had substantial work at the Department of Health and Human Services, because of this report.

We have been engaged in a variety of issue briefs and have done it over time but have been more active in publishing issue briefs over the last year. These are generally ways of highlighting an issue, bringing issues to bear, but we don't have the authority to make recommendations that can come from a longer learning community out of a task force. Our most recent task force report was on quality metrics in health care and this was published a month ago.

I wanted to mention our next task force because I think there are things that overlap with some of the issues important to the Deaf and Hard of Hearing community that we will be tackling in this task force. We are calling this Accountable Care communities; this will help us think about how community-based organizations, providers and communities come together around shared responsibility, investment and saving to invest that stream in social determinate health in ways to improve the health of the communities. We will start this in January.

We publish a bi-monthly North Carolina Medical Journal (NCMJ) sent out to 170,000 people, mostly healthcare providers, all the members of the General Assembly, CEOs of hospitals, nursing homes, health directors, and the like. We did an issue on hearing and vision challenges in North Carolina. Everything we publish in this journal is available on our website.

The meeting we had last week, we had 19 people in attendance; several of those people are in the room today. We had six members of our staff and 19 guests last week, including representation from a variety of divisions within the Department of Health and Human Services including Medicaid, mental health, services for deaf and hard hearing, office of rural health, two other insurers in the room. Several advocacy organizations were represented, the health care association that represents skilled nursing facilities and leading age, the association that represents our retirement communities in North Carolina.

We talked about access to qualified interpretation services and access to appropriate assistive technology, screening diagnoses and assistance to technology and nursing health. One of the questions I will add today is where else should we be focusing?

What Jan Withers and I wanted to do was to identify: are these important issues to be talking about to a broader range of stakeholders, do people want to move forward with us? What are the opportunities for solution? Where is there consensus? This was the start of a discussion which, I know, my staff found very productive.

I thought I could share with you some of the slides others presented but I suspect many of you know that this is a big problem, an important problem, this impedes access. We talked a lot about the growth of the Deaf and Hard of Hearing community, projected by 2030 we will have 1.7 million North Carolinians that are Deaf or Hard of Hearing. We talked about the financial ramifications; we talked about the health consequences to the Deaf and Hard of Hearing population, limited access, to services generally. We all also talked about what makes a person a qualified sign language interpreter in the medical setting.

We also had a great presentation by Disability Rights North Carolina about the responsibilities of providers under the ADA and other state and federal statutes.

We talked a little about the role of healthcare providers, how we might start to solve this problem talking about what we have been calling Communication Access Fund, a fund where either interpreters or providers can draw down pay for qualified sign language interpreters, thinking about the expense to providers that may be a barrier to providing what is their legal responsibility.

We talked about the required CMS assessment in skilled nursing. What we don't really know and didn't talk much about is how well we are doing with complying with federal regulations in nursing homes. There is a profound challenge for skilled nursing facilities and socially isolating for skilled nursing residents and leads to further functional decline and further medical consequences.

At this point the North Carolina Institute of Medicine and Division of Services for the Deaf and Hard of Hearing are going to be engaging in further conversation to look at the best ways for us to move forward. Jan Withers and I have a mutual interest in moving forward on this conversation, I think we would like to talk about what might be in scope for a task force, what issues might we try to tackle, there are two, I suspect others, I am not sure if this is enough, starting with access to qualified sign language interpreters and access in skilled nursing facilities is enough but I would like to hear from you all what you think the other real challenges look like and if there are really good ideas for how we might solve these problems together.

Educational Interpreting in North Carolina: Updates

Lee Williamson, Communication Access Manager

NC Division of Services for the Deaf and Hard of Hearing

I’ve talked with our Interpreting Services Specialists’ that are housed our regional centers; the most common request they get pertaining to advocacy for communication access are in health care settings. Doctor’s offices not providing interpreters, hospitals using video remote interpreters when the request is for on-site interpreters, which by law they must provide when requested. It's such a huge task that we need to collaborate with the Institute of Medicine and get Dr. Zolotor to help with the process.

The other area we are working on and trying to improve is educational interpreting. The North Carolina Department of Instruction (DPI) has begun to look at educational interpreters in North Carolina, and Antwan Campbell, the Interpreter Specialist for the DPI approached our division to ask for assistance in looking at educational interpreters across the state, assessing what we can do to improve their standards for interpreters in the schools.

Currently, interpreters who work for a fee or compensation in the community must have a license to work and practice. In the educational K-12 and post-secondary settings, that accountability isn't there. The K-12 schools, public and charter schools go by the educational interpreter performance assessment. It's an assessment of educational interpreting skills. There’s a rating system, with rates from 1 up to 5, the most proficient. It's also divided up into elementary and secondary. A person can be tested on ability to interpret in elementary or high school. You can choose modes of communication. There's American Sign Language and a continuum of sign language going from signing exact English to cued language transliteration. You have this whole spectrum that the interpreters can be tested on.

The school system has set up a standard of a three with a 3 being intermediate level of competency as a sign language interpreter. That's being generous. A 3.0, if I took what you see on the CART screen here, if I marked out 60% of the words that you see on there, that would be how much comprehension a student would be getting, basically, if you could do a comparison of English to sign language. Think about how much work a child has to do to learn. That’s here in North Carolina and we are trying to figure out a way to get these interpreters better, more qualified.

Antwan has developed a pilot program; he has selected, introduced and explained this at the Council meeting in May. We have a few new council members who could catch up by reading the minutes for the May meeting. Antwan, Pam King, a DSDHH interpreter, and I are working together to provide coaching and mentoring along with professional development skills on a specific number of interpreters.

Selection of Cohort

• May 2017- Cohort of 28 educational interpreters selected in Pitt, New Hanover, Wake, Moore, Guilford, Mecklenburg, Burke, Buncombe Counties

• June 2017 – August 2017 – EIPA taken by cohort members to establish baseline

Coaching

• October 2017- Coaching Training

• 6 Interpreting Services Specialists (ISS)

• 2 ISVL mentors

• 1 Cued Language mentor

• October 2017 – June 2018- Coaching Sessions

• 4 face to face sessions

• Create professional development plans

• Assign deliberate practice activities

Professional Development

• October 2017 – April 2018

• Global professional development provided by DPI

• 4 workshops/trainings

• June 2018

• Cohort re-takes the EIPA

Hopefully, once this is done in June, they will re-take the EIPA and see the differences in scores. I hope we will have more information to share. We’re just starting. DSDHH’s Interpreting Services Specialists have just begun to provide assistance. We hope to have an update for the Council at the next meeting.

Denise Nelson: I am the Council's representative on the task force giving guidance to this whole process for educational interpreters. One thing I wanted to add to that is this kind of initial pilot group is important because we will look at the progress they make as a result of the mentoring to help decide what the new standard should be as far as 3.4, 3.6. Looking at the progress they make under this mentorship will determine a realistic goal to set for the interpreters as we go along.

Certified Deaf Interpreters: Their Role and Benefits

Lee Williamson, Communication Access Manager

NC Division of Services for the Deaf and Hard of Hearing

Karen Gabriel, Certified Deaf Interpreter

Lee Williamson: Deaf interpreters are certified interpreters who are deaf, native sign language users. It’s a profession we need to take advantage of.

At DSDHH, we strive to increase the pool of interpreters in North Carolina.

In 2013, we started our first real initiative on training Deaf Services Specialists at our regional centers to become Certified Deaf Interpreters. At the end of that year, we had one certified deaf interpreter in the state. Now we have two. In September, we had three individuals just became licensed deaf interpreters and have joined the profession. We have more taking the training to become provisionally licensed as deaf interpreters. In North Carolina, you need to take 16 hours of training in interpreting course work. They must take one workshop in role and function or ethics. They are also to have 20 hours of actual interpreting experience, under supervision. Once they have 20 hours of interpreting and 16 hours of course work, they can apply for provisional licenses.

The Registry of Interpreters for the Deaf has a moratorium on the performance test. The Certified Deaf Interpreter performance test is now being reviewed for validity. In order for Deaf Interpreters to be licensed in North Carolina, they must pass both the written and performance tests. But because of the moratorium, the licensure board is granting extensions to our licensed interpreters.

Why do we need a deaf interpreter when they can't hear what's being said? Karen Gabriel will talk about that. She's been doing a lot of training, a lot of work and does great things for us and we have learned a lot from Karen since she's come to North Carolina and brought a wealth of knowledge to North Carolina. I want to thank Karen for all she's done and I look forward to hearing her share with you what deaf interpreters are. I hope this can be a solution to a lot of the problems we talked about, including medical interpreting, educational interpreting, and so forth. Having a Deaf Interpreter will help resolve some of the situations we are seeing with access.

Karen Gabriel: I’ve been a Certified Deaf Interpreter (CDI) since 1999. The Deaf community wants training to develop their expertise to become provisionally licensed so the field can grow more.

Definition of a Qualified Interpreter

- ADA definition – Qualified interpreter

- Effective

- Accurate

- Impartial

The Role of the Deaf Interpreter

- Work effectively as a team with a hearing interpreter

- Make communication possible (use of gesture, mime, props, and other tools)

- Understand the subject matter

- Include cultural information

- Be versatile, flexible, skilled

- Confidentiality/Follows the CPC (Code of Professional Conduct)

What is a CDI/DI

- Specialist vs. Generalist

- Language & cultural specialist

Benefits of Using a CDI

- Optimal understanding for all parties

- Efficient use of time & resources

- Clarification of linguistic &/or cultural considerations

- Clear conclusion

- Increased trust from Deaf consumer

When should CDI/CHI (Certified Hearing Interpreter) teams be used

- Legal/ Medical/ Mental Health

- Emergency broadcasts on National TV if CHI/CDI have training beforehand

- IEP meetings (Deaf Parents/ Deaf Student)

- Advanced courses in Educational Settings

- Deafblind

- Deaf Plus (Deaf with other disabilities)

- Non-Standard ASL user

- Professional Conferences

Other factors that determine the need for a CDI

- CP/Deaf who had a stroke / missing fingers

- Deaf who constantly give false confirmations or repeat after you

- Rochester Method (only fingerspelling)

- Oral D(d)eaf

- Legal documents/contracts to be signed

- At Deaf person’s request***

Explain the justification

- Client communication abilities

- The majority of ASL/English interpreter’s first language is English

- A CDI is a Deaf person whose first language is ASL

- Therefore, the CDI will be providing the most accurate communication/interpretation in a situation.

Professionals who work with the Deaf or Deaf Blind, Interpreting Agencies, Interpreters, and Hiring Entities need to know that….

- A CDI/CHI team would provide best effective communication for

- Any NON Standard ASL user

- Indigenous Signer

- Deaf from another country

- Deaf person who was institutionalized or isolated

- Deaf who uses gestures

How do you interpret this?

1) Do you hear voices?

2) Have you thought about hurting yourself?

3) What grade are you in high school? (for Deaf/Blind)

4) Have you struggled with addiction to a substance?

5) The lab results show that you are HIV positive.

6) My mother-in-law passed away.

How to get a DI/CDI

- Contact nearest DSDHH office for list of licensed DI/CDI

Resources

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H.R. 620 -115th Congress (2017-2018): ADA Education and Reform Act of 2017

Tovah Wax, Chair, NC Council for the Deaf and the Hard of Hearing

Congress is working on a revision of the Americans with Disabilities Act (ADA). This current proposed reform would be to make it much more difficult for people to file complaints or sue for violation of the ADA. I urge any of you who have any issue with that to contact your legislator. In Council member folders, we have a list of ways you can contact your representative. If the Council has thoughts how to address this issue on the federal level, then we can talk about that in committee.

NC Council for the Deaf and Hard of Hearing Business

Tovah Wax, Chair, NC Council for the Deaf and the Hard of Hearing

This past summer, council members received IRS information regarding how to receive reimbursement for participation in Council.

Jan Withers: In order to get per diem, you have to fill out the paperwork and file a W-2, or ask to be waived and you wouldn't get per diem.

Tovah Wax: So how can people get that information about filing for the W-2 form.

Jan Withers: People who are exempt from that are people like Kevin Earp, who represents a state government agency, or a member of the legislature. Everyone else here should have already received a letter, either last summer or just recently a few weeks ago. If you don't know what I’m speaking of, please see me.

Tovah Wax: if you feel like you aren’t getting communication about Council business, please let me, Rene Raeford or Jan know.

The bylaws are now available on the DSDHH website for anybody who wants to review or have access to them. We also want to mention that Michele Neal, who was with DPI, has retired, and we are looking for a replacement for the DPI position on the Council. Apparently, the governor's office is considering some names, so we should soon hear who will be the replacement for DPI representation on the council.

The other thing I want to mention: some of you have apparently asked when and where the next meetings will be. Notice at the bottom of the agenda, you will see when the next two meetings are and where they will be. Also note the website address is on the bottom of the agenda as well; you can access the website for information about any council business.

Glasses Are Cool. Why Aren’t Hearing Aids?

Tovah Wax, Chair, NC Council for the Deaf and the Hard of Hearing

There was an article in the New York Times questioning why are glasses cool and hearing aids not. From the 1920’s through the 1950’s, glasses were not considered cool then somehow all of a sudden, they became a fashion item. people started accepting and wearing glasses. Even some people who didn't need glasses were wearing glasses because it was a cool thing to do, a fashion statement of some sort.

I remember I used to wear hearing aids before I got cochlear implants. My mother used to tell me to hide them, keep them discreet, and not let people see my disability, my hearing aids. I used to feel ashamed and embarrassed all the time about wearing hearing aids. In my 50s, I got cochlear implants, and then somehow cochlear implants were cool.

I was so glad to be rid of hearing aids. When I saw that article, I thought, why was that the case? How are hearing aids not cool? Cochlear implants and glasses are? I thought it would be interesting to raise the question and have a light-hearted, maybe profound discussion about why that is. I know for myself, I can say that one reason I found hearing aids somewhat not cool was because there's a sort of hygienic issue. There's a mold in the ear and sometimes it gets clogged and you must take it out, clean it. People don't want to see that. It's like flossing your teeth in public or something like that. So that was my sense of how to deal with hearing aids in public. Somehow, cochlear implants don't bother me at all; I can stand in the middle of the store, change batteries and not be self-conscious about it. I am curious what others think about the coolness factor of hearing aids versus glasses.

Deborah Stroud: When I got hearing aids, I guess at that point in my life, I was very vain, embarrassed, didn't want people to know I had hearing loss. Took me a long time to even go to the Hearing Loss Association meeting because I thought it was just for old people. I thought only old people have hearing problems. Now I am one of the old people there. When I got cochlear implants, for me it was like even bigger than hearing aids on my head, but it gave me my life back and so now I really enjoy being able to share my story and I am proud of those things on my head, so anyway, I don't have that vanity anymore for one thing.

Julie Bishop: My experience with people coming to chapter meetings that it's an age issue. I know the first time I went to one I was in my early 40s. It was at the Cary Senior Center - that was hard for me. I walked in the door and I saw white hair everywhere. I wanted to turn around and leave but I didn't. For me, nobody enjoyed conversation more than I and to lose that ability, just trumped everything. There are people like me who don't care, they will wear the hearing aids, do whatever to hear. I think most people that develop a hearing loss, as they age, it is an age factor, but with the news of iPhone-connected hearing aids it's starting to become cool. I think we will see that change.

Denise Nelson: I think we are going to see a generational shift. I see children who come to school with pink hearing aids, polka-dotted cochlear implants, all kinds of different decorative features to their amplification. I think the stigma is changing, at least for the younger generation. Also, you see more and more people having all kinds of other technological things around their head that, I think also may reduce the stigma of having this thing attached to you. That may be an overly optimistic view, but I think we are going to see somewhat of a generational shift.

Tovah Wax: I hear two things. One, there's been an association with aging. It's a realization you are aging, hard to face sometimes and maybe changing technology and the stigma factor. I do remember walking around seeing people looking as if they were talking to themselves and then I would realize that they are talking through their Bluetooth phones and they look like hearing aids or cochlear implants. The distinction between cochlear implants and the Bluetooth phone is disappearing, technology may be a factor.

The New York Times article was talking more about the aging issue, the fact that hearing people, when they start to lose hearing, it's still a big important difficult issue, especially about hearing, almost more than any other disability, because of the centrality of communication.

Reports from Committees

Education Committee

Committee discussed the Educational Interpreter Task Force and where that pilot program stands right now. The committee does not have any new recommendations at this moment. The committee also discussed Pre-K Education for three to five-year olds who are Deaf and Hard of Hearing. It’s an area of concern and an area that is being considered at the state level and there is a stakeholders group that is looking at three to five-year-olds for Deaf and Hard of Hearing students. Council Member Denise Nelson is part of that group and says the group has only met twice, once in August of 2015 and the other June 2017. The group has not been active lately and it’s probably since DPI staffing has been reduced in the Deaf and Hard of Hearing area and they are in the process of hiring new people. Hopefully, this increase in staffing will give them the ability to focus on this area. We will see what happens and we’ll keep pushing.

Community Committee

The committee discussed hearing aids and the article that was raised earlier and the perception of hearing aids and why people aren’t taking advantage of hearing aids. The committee talked about insurance and ways of identifying hearing loss awareness and how we can best encourage people to learn more about hearing loss and what they can do about it. The committee talked having appropriate staff in the appropriate places to make it awareness happen. The committee also discussed ways of implementing the care of seniors with a hearing loss in nursing home facilities.

Motion: Tovah Wax will draft a letter for the Council of thanks and appreciation to Dr. Adam Zolotor for the North Carolina Institute of Medicine (NCIOM). The letter will also thank Dr. Adam Zolotor for presenting at the council and to encourage him to establish a task force to study the needs of Deaf, Hard of Hearing and Deaf Blind consumers in the medial communities in North Carolina. Motion carried.

Announcements

DSDHH has hired, through temporary solutions, a retired veteran. The position is called Veteran Liaison and will be a pilot program that will focus on the western part of North Carolina.  He will work part time and will be housed in the Asheville Regional Center. The vision of this position is to help DSDHH open doors to connect with veterans that have hearing loss. 

The Hearing Loss Association of America held its North Carolina Walk for Hearing and it was extremely successful. Over 500 people attended. Julie Bishop stated it would be great to have many more groups or associations to attend.

Adjournment

Future Meetings: February 2, May 4, August 3, November 2

NC Joint Forces Headquarters, 1636 Gold Star Drive, Raleigh, 27607

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