NC Council for the Deaf and the Hard of Hearing



NORTH CAROLINA COUNCIL FOR THE DEAF AND THE HARD OF HEARING

Quarterly Meeting Minutes

May 12, 2017

9:00 am – 3:00 pm

Joint Forces Headquarters, Raleigh, NC

Members Present:

Julie Bishop

Craig Blevins

Timothy Boyd

Mary Crump

Kathryn Dowd

Kevin Earp

Ericka Gagnon

Lester Latkowski

Johanna Lynch

Kunal Mitral, M.D.

Brad Trotter

Tovah Wax

Ex Officio:

Jan Withers (Present)

DSB Liaison:

Kim Harrell (Present)

Members Absent:

Kathryn C. Aldridge

Rep Hugh Blackwell

Christina Bryant

Bud Cayton

Rep Beverly Earle

Mary Edwards

Meredith Kaplan

Ray Lewis

Betsy Moore

Denise Nelson

Senator Bill Rabon

Debrorah Stroud

Senator Jeff Tarte

NORTH CAROLINA COUNCIL FOR THE DEAF AND THE HARD OF HEARING

Quarterly Meeting Minutes

May 12, 2017

9:00 am – 3:00 pm

Joint Forces Headquarters, Raleigh, NC

Introductions, Announcements, Approve Minutes from February 10, 2017

February 10, 2017 minutes were approved.

Motion: Johanna Lynch motioned to approve the minutes from the February 2017,

Council Meeting. Motion carried.

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

Educational Interpreters in North Carolina: Update

M. Antwan Campbell, Specialist for Educational Interpreters and Cued Speech Transliterators, NC Department of Public Instruction

I'm the new Educational Interpreter Specialist and Transliterator for the Department of Public Instruction. I've been on the job about four months, I'm going to tell you what’s going on with our educational interpreter cohort that we are starting. We're excited about this process and this program and hopefully get some good information and improve the services for the schools. We have a variety of people representing different groups across North Carolina and different school systems in the Local Education Agencies (LEAs) as well as interpreters with different score sets from three to a four. This group started to look at the process for educational interpreters and requirements for educational interpreters as well as trying to make the determination to make a recommendation to the State Board of Education on increasing the score. Our main platform is consistency, making things consistent across the state of North Carolina. We want to have a system in place with supports to access and give support to interpreters as well as the students. The group has come together and addressed professional development and the coaching and the mentoring piece. We look at the implementation and competency drivers, coaching, selection, cohort, technical and adaptive systems as well.

We are in the implementation stage for this year. It is a two to five year process and this is year two. Here we look at communication and visibility, professional development, coaching and mentoring piece and research and evaluation. We want to build student language and literacy capacity, to meet grade level requirement and we want to make sure our kids are learning appropriately and have staff in place to help them. We want to continue to build capacity for interpreters, transliterators and language facilitators by providing quality coaching, mentoring, professional development and supervision based on research-based practices. We want to continue to build and strengthen partnerships with institutions of higher education, state agencies and community stakeholders to advance complementary strengths, identified resources also research-based training and implementation science to create sustainable systemic change.

Updates from April 7th Stakeholder Meeting

• Research/Evaluation

- Analyze data for current educational interpreters

- Educational background (2 or 4-year degree)

- Analyze the mode of communication used on EIPA & results (ASL, MCE, PSE)

- Research licensure requirements for educational interpreters in other states

- Study how interpreters are currently evaluated and Paid

Coaching

• May 2017

- Administrative trainings

- Selection of Cohort 1

• June 2017

- test initial group to develop baseline

- interpreters in Cohort 1 should have variety of skill sets/experience

• June – August 2017

- Coaches will receive training

• Sept 2017

- Develop professional development plan for interpreters with coach.

• October – June 2018

- Coach will provide support and feedback 4 times a year beginning in the fall

- Work with Deaf mentors

Professional Development

• Interpreter professional development

- Language development for interpreters

- How to interpret for differing language levels of students

- Receptive skills

• Administration/Parent professional development

- Understanding of language levels of students with expectations in mainstream/resource/self-contained classes

- Evaluation process

Communication

• Educational team/LEA/educational stakeholders will have the biggest impact

• How do we balance information so it’s not too long or short

• Internal stakeholders are the highest priority to get information to as it will influence other

external stakeholders

• Communicate effectively with educational interpreters in order to alleviate fears/concerns

• Information should be disseminated as soon as possible to stakeholders via wiki page



Next steps

• May-Jun 2017

- Cohort 1 identified

- EIPA testing begins

• June-September 2017

- Coaches training

- Individualized interpreter plan developed with coach

• October 2017

- Coaching and professional development plan begins

Questions or concerns from the Council:

Question: Tovah Wax asked: is there any research or incorporation of research about the impact of interpreters in the classrooms from the point of view as teachers, parents, as well as the students themselves, either here and/or in other states as well?

Antwan Campbell answers: There is research on that. We haven't done research ourselves but we have gotten research from outside sources.

Question: Craig Blevins asked what is the goal; is it to improve the scores of interpreters to get them above a 3.0 or to support the interpreters that are already in the system.

Antwan Campbell: The overall goal to support the interpreters working in the school system, but we are looking at increasing the score, the determination has not been decided, whether it would be 3.5 or 4, but we're looking at how we can support them overall.

.

Legislative Update

Jan Withers, DSDHH

There are three bills directly related to law enforcement that could have an impact on the Deaf and Hard of Hearing. The first one is called the driver instruction law enforcement stops. Basically, this bill focuses on making sure that the driver's education program for students teaches students how to behave when they get pulled over. We are hoping that that training will also include what needs to happen when a law enforcement officer stops you in other types of situations, maybe walking down the street and stopped by a law enforcement officer. Not just traffic pullover stops.

Another bill that has been introduced is the driver's license Deaf and Hard of Hearing Designation. We also have had an opportunity to talk with the North Carolina Association of the Deaf and the North Carolina State Highway Patrol and a few of the stakeholder groups to get a feel for their opinion about such a bill. We met with the bill sponsor, who listened to our concerns. We realized that the bill that she first drafted could benefit from some changes that she was open to; therefore, we were able to improve on the bill. She called a special committee meeting, specifically for hearing our feedback. A representative from the North Carolina Association of the Deaf, Hearing Loss Association of America, Department of Motor Vehicle (DMV), State Highway Patrol and DSDHH were there. We provided feedback and it is satisfactory to all. We are pleased with the changes made to the bill. The bill allows deaf and hard of hearing people to voluntarily notify the DMV that they would like for their driver's license and the database system to reflect that they are deaf and hard of hearing but in a discreet manner and will ensure the security and privacy of the deaf and hard of hearing individual.

The bill also includes a requirement that law enforcement officers receive training on how to interact appropriately with deaf and hard of hearing people and includes a requirement that law enforcement agencies, for example, the Department of Public Safety and the state highway patrol, consult with DSDHH on best practices. That bill has passed the House with no opposition, and I believe the vote was like 111 vote in favor and zero opposed. It did make the crossover and we're hoping the Senate will pick it up.

The third bill requires the Department of Public Safety to do a study on officer interactions with people with disabilities. We proposed a language change to make sure that it includes people that have disabilities or people that provide services to people with disabilities to make sure that the folks writing this bill have expert consultation throughout the process. We'll see how this moves forward through the Senate.

I would like to mention a different type of bill and this is related to occupational licenses. Last year, the legislature was thinking about the possibility of eliminating the licensing board for sign language interpreters and there was a list of several different occupational licensing boards that they were looking at eliminating. That action was stopped. They were asked not to do that. The reason we don't want the board to be eliminated is that sign language interpreters have a huge impact on the health and safety of deaf and hard of hearing people and those professionals that serve you. We need to make sure that their services are communicated effectively and provided efficiently. We wanted to make sure that licensing for interpreters remains. There is still a bill there related to licensing boards, but it's geared more towards oversight of the licensing boards. The bill that was introduced last year with the goal of eliminating the licensing boards has gone away, so we’re safe.

I have information from the Division of Aging and Adult Services and I’ve asked if they thought that any of this would have any impact on Deaf and Hard of Hearing Services. There are several bills going through the legislature at this time that have crossed over to the Senate, and one bill specifically requires the Department of Health and Human Services to conduct a study and to recommend a tele-medicine policy. I'm not sure exactly what that is going to mean for deaf and hard of hearing people. There are pros and cons to tele-medicine, but we will keep our eyes on that.

There's another act called the Senior Fraud Protection Act, which is a big issue for senior citizens and particularly senior citizens with disabilities. This bill proposes that the AG's office operate and maintain a database that can be used to investigate financial fraud or financial exploitation; we are looking at how we can best make sure that deaf and hard of hearing people are not overlooked within this work. Now, I would like to open the floor, if anyone wants to share maybe from the Division of Mental Health or Vocational Rehabilitation or does anyone here on the Council or in the room know of any other bills that need to be brought to our attention.

Kevin Earp: We're looking at the budget for Vocational Rehabilitation (VR), Division of Services for the Deaf and Hard of Hearing (DSDHH) and the Division of Services for the Blind (DSB). We want to make sure everything is the same and consistent without loss of position. Everything is good with that, there's no loss of programs or anything like that, that’s a good thing. I do have one question related to the second bill, is it on the license itself or on the license plate to be identifiable; if a police officer looks at the plate and call it in, is that how it's going to work.

Jan Withers: No, the feedback that we got from the community is that people are clearly opposed to having any type of designation on the driver's license plate. If we have something on the driver's license, that would be a discreet number that only law enforcement knew what the code meant, it would be private.

NCCDHH By-laws

Tovah Wax, Chair, NCCDHH

When Jan and I talked about this meeting, and my becoming chair, I had asked about the question of vice-chair. I was worried if I couldn't make a meeting, there would be somebody to help run a meeting of the Council. This led to reviewing all the bylaws. We made some changes in the wording to make things a little clear. Example, on the first page (handouts), you will see under section 2, number 2, where we added the word "people" instead of calling everybody "deaf and hard of hearing," we call them "deaf and hard of hearing people," because we are individual. I will go through the changes that we're proposing and then we will open for discussion, and certainly during committee meetings, we can make any proposed changes or revisions if necessary. Let’s be clear, to vote on the bylaw changes we need a quorum and we have a quorum today. The quorum is 15 people, given our 28-person membership. Any changes in the bylaws will not take place until the next meeting. Tovah Wax asked Jan if this was right.

Jan Withers: No, the bylaws must be presented in writing during a regular or special meeting, such as what we have today. Action on the recommended changes does not occur until the next meeting, not at this one, then it's effective as of that date.

Tovah Wax: Changes would not happen until the next meeting.

Jan Withers: Yes, that is correct.

Kevin Earp: Yes, I do... I would like to express my opinion and I do have some clarification on this. We may want to look at maybe editing a few things, if possible. Section 3, talking about the quorum.

Jan Withers: Which article; which part are you looking at.

Kevin Earp: Article 3, it says "the simple majority members are 15 out of 28 individuals." It shall be a quorum. My question about that, I think I need more clarification on the quorum component of it. Should we maybe edit or tweak that to maybe saying "members present" rather than a specific number of members.

Tovah Wax: You’re asking that we should add “members present” at a meeting.

Kevin Earp: Yes, eliminate the 15 out of 28 total. I think we should take out that section. Instead of putting the majority, just say a simple majority of council members present shall constitute a quorum.

Tovah Wax: My understanding of this ruling is that a simple majority or a quorum count must be based on the number of members the Council has. So, if the Council has 28 members, we expect 28 members to show up. If they're not all here, we at least should make sure we have the right number. Right now, we have 28 members. If we change down the road and only have 18 members, the quorum number would change. So, I guess that's the reason why we had to put a specific number. Any other thoughts on that?

Kevin Earp: From my understanding, when you say the simple majority, that would mean that you're using the number 15 out of 28 total, you're using that specific number, so I guess the problem is we don't have 28 members.

Jan Withers: This means 28 positions on the Council. I think what you're saying, Kevin, is you're wanting that to be changed to many of those members who are present during the meeting.

Kevin Earp: Yes, that's absolutely what I mean.

Tovah Wax: When you have a total membership, I think you should make sure that you have enough members representing a vote. If you have 30 members on a Council and only 10 show up at a meeting, that means only six people would vote to pass something, leaving the vast majority of members out of the picture. I suspect it is important to know how many members there are to know what constitutes enough representation for passing a vote. My guess would be, it probably is appropriate to keep the number in there so we know how many positions there are and therefore what most that would be. The number could change. At some point the Council membership may change and be fewer or more members depending on the need at any given time. Then the number of majority would change also. Does that make sense?

Kevin Earp: Yes.

Tovah Wax: We simply made a simple change to represent deaf and hard of hearing individuals. On page two in your paper, section three, conflict of interest, we made a minor change to clarify that the Council adhere to all state laws, rules, policies and/or executive orders. Before we had written specific executive orders, but then we realized there could be nuanced and they could be changed or rescinded, so we changed that to reflect any current, existing and in effect orders, rules and policies of Council action.

The next section is Article 2, Council Membership. The 2004 bylaws listed all the members and how they are appointed, but it appeared to be easier to clarify which members are appointed by the governor directly and which members are appointed by other agencies or representatives. First part we grouped together all those that were appointed by the governor. Then the second part we grouped all those that were appointed by others, like the House of Representatives, the Senate, DPI, DSDHH and so on. Note there were no change in actual members, just a change in the way we present who was appointed by whom. Any questions regarding that section?

Erika Gagnon: I was wondering, is it possible to talk about adding members that are appointed as an audiologist representing cochlear implants. I think it would be important to have a physician, like an ear, nose and throat doctor. I have many patients who are oral and in the systems who could benefit from having a speech language pathologist on the board.

Tovah Wax: Jan, can you respond to that?

Jan Withers: Yes, what is listed in the bylaws is dependent upon state law. We cannot deviate from it at all, because they're listed in the law. We basically are able to clarify the language, which is why we added the phrases pursuant to and then the General Statute 143 (b) 216.32. The meaning is still there and the bylaws is clearer than how it's written in the statute.

Tovah Wax: I think the question is, if the Council felt that representation would be important, what would be the process of asking for a change.

Jan Withers: You have to find a bill sponsor, a legislator who would sponsor the bill and when you propose an amendment to any statute, you open up the whole statute to all kinds of changes. This can be very risky. It's a risky move to make just one minor change. Generally, it is best not to unless you do have a few changes that need to be made that are key to the bylaws. To address your question, maybe an alternative way to bring in experts like speech language pathologists is to invite them to the meeting and bring them into the discussions and get their input and so forth.

Kevin Earp: On the next article down, article 3, under the Council meeting, below that, adding in section 2 where it has "notice of meetings," I do have to say that things are so much better than they were before. Kudos to DSDHH and the staff for getting the minutes out there and everything. It is wonderful. Before it was like pulling teeth getting anything, but it is so much smoother, kudos to your staff and we appreciate it.

Jan Withers: Thank you!

Tovah Wax: The next section we modified is article 3 at the bottom of page 3, section 2 about notice of meetings. We just basically cleaned that up a little bit, because in the 2004 bylaws, it was a bit of redundant language about being notified of meetings or special meetings. Special meetings of the council are those called in between regular meetings for specific purposes. It's something about that later in the bylaws. We already talked about section 3 on the top of page 4 about the quorum. Any further issues about that?

Kathryn Dowd: I'm a new member on the Council and I do agree about having a simple majority of those that are in attendance when there is a vote. You can't always mandate people come if they're sick or whatever. It's like a vote in the legislature, if people don't attend when they hold a vote, they still take the vote and it's most of those in attendance. It seems like having that would not hold up any decisions by the Council. That's just my opinion.

Tovah Wax: It's been my understanding that even in legislature, if there's not a quorum, you can't vote on things because there isn’t enough representation.

Jan Withers: That’s right.

Tovah Wax: If you have 28 members and only 10 show up for a meeting, a simple majority would be 6 people out of 10. That's less than one-fourth of the entire membership. It would be difficult to adequately represent people.

Brad Trotter: I've been involved with the Council for several years and have never seen only six people show up.

Tovah Wax: That’s true, we also have less than a quorum at times.

Johanna Lynch: I just wanted to point out that further down in section 5, it says that we can do approval of business that can be conducted by a teleconference, video conference or email. If there's something urgent, would we be able to as a Council vote on something via email and that would solve the issue of the quorum.

Tovah Wax: I'm not sure how to respond to that, Julie, you've been chair, help.

Julie Bishop: Four years that I served as chair, maybe two times we didn't have a quorum. That's usually the August meeting; it was never an issue.

Tovah Wax: There seem to be a contradiction or a difference between the section 3 and section 5 language. One possibility is to eliminate the actual numbers and speak to a simple majority. The other possibility is maybe to modify the wording to reflect making sure we have a quorum for any decision, that the voting should happen either at a meeting or through emailing. Is that one way of resolving that issue?

Craig Blevins: Just out of my curiosity, today we have 14 people here. If we wanted to suggest or bring up new business, could we not go ahead and do that.

Kevin Earp: I think we are reading this wrong.

Jan Withers: If I may, Tovah, are you talking about Article 3 and Article 5.

Tovah Wax: I think we're talking about Article 3, Section 3 and 5.

Jan Withers: Article 5, Section 3, that is about the executive committee, not the full Council. There is clarification needed there.

Tovah Wax: Article 3, Section 3 and 5, Section 3 and 5 within Article 3. I think we're talking about Section 3. It says a quorum should be a specific number, but Section 5 says we can do both through special meetings and/or through emails. It sounded like what we are suggesting is we're modifying the wording or clarifying the wording to say that a quorum must vote on whatever matters, but that vote may happen either at a meeting and/or through email between meetings. That’s a possible way of resolving that issue.

Kunal Mitral: I think in Section 4 it says the whole sentence "until unless otherwise stipulated in the bylaws" and stipulated in Section 5, special meetings may be called because of the chair. I think it's not necessarily in contradiction, because it does say "unless already stipulated." If you provide notice, special meeting via such and such communications, then you can go ahead and conduct business and maybe if you wanted to, maybe provide some clarification that you could have a vote through the special meeting, maybe that would be helpful.

Tovah Wax: So it's possible to change that language. It seems like a few of you feel more comfortable with changing the language to a simple majority. However, there is one consideration, I think raised already by Craig that we're expected to show up at these meetings. If you know that you can vote by mail, why would you bother coming to a meeting if you were coming from far away. I think one of the issues is having bodies present, you know, the idea of these meetings is for people to get together to be able to meet and talk about issues. My opinion and just my own individual opinion, that it might be better to keep the number in there.

Kevin Earp: I think what we're looking at here is the interpretation. Everyone is interpreting this sentence differently. And the one thing that I'm also thinking of is the number, 15 out of the entire Council being present. That's what this is saying, right. It makes sense at first glance, but if we think about positions that are vacant, I think that's where issues are coming up. When you have several vacancies like we have today, it just happened that some of the positions are vacant and we're still waiting for the governor’s office approval. I think once those vacancies have been filled, I think we'll be fine and number won't be an issue. But during the time that specific period, we need to meet a quorum for something, so I guess that's where our issue is a little bit murky. We're not sure how to address this entirely.

Tovah Wax: What I'm going to recommend is that perhaps to save time we take this discussion up during committee meeting or during correspondence and try to work out a language that reflects better what the intent of this section is. Would that be acceptable, to work on editing that section a little better to clarify those issues? Next modification we made was in section 5 about special meetings, mostly to clarify the language about how notice is given, how communications will happen, and what kind of approval of Council business happened during special meetings. Moving on to Section 6, Procedures. This section is dependent on a later section when we talk about a vice-chair position. If we approve a vice-chair position, then we are suggesting to add that the vice-chair could be one of the duties of a proposed vice-chair to be serve as parliamentarian during meetings, and that depends on approving a vice-chair in the first place, but that's the language we were planning to put in there in that case. In Section 7, we updated forms of communication, because technology had changed. We now have email, regular mail, smart phones, all ways of communicating about meetings.

Article IV, the section about Officers, the bylaws, the state law, statute, that governs our action stipulates that the officers are appointed by the governor. In this case, we happen to only have one officer effectively. There is no provision in the statute for a vice-chair. That's something that we as a Council can decide we need or want. We are proposing that a vice-chair be elected and voted on by a majority vote of the Council. Because we are proposing the addition of a chair we separated out the duties of the chair and then proposing to add a section on vice-chair and what the vice-chair duties would be. Look at Page 5, this would-be Article IV, Section 2. We have duties of the chair now being distinguished as unique responsibilities of the chair. Moving down a little bit, again, if we have a vice-chair, a duty of chair could be to serve -- that a chair could become vice-chair after completion of term as a chair. That's one proposal. Part B, I should have said proposed duties of vice-chair, if we have a vice-chair. These include these various things, including a chair during Council meetings when the chair can't be there, serve as parliamentarian and oversee and help with the standing committees when they are meeting. Article V because we're proposing a vice-chair, we've changed some of the wording to reflect that executive committee would include a vice-chair as well as the chair or representative from any standing committees. Now, up until now we've had a few different types of standing committees or names for the standing committees, like the Education Committee, the Communication Committee, the Community Committee. What we decided to do was eliminate the specific names of these committees to suggest that whatever standing committees we do have would have a representative on the executive committee. Later in Article V on Page 6, Section 6, we added the language committee members are expected to attend committee meetings and absent from two consecutive meetings would require written notice or alert to the members about their commitment to the Council. We've had one situation already where someone had not been responding to our attempt to contact the person about coming to meetings, which kind of raises the question about whether that person can come, is prevented from coming or some other reason why they can't serve. This is a way of ensuring our members maintain a commitment to attending to or participating in meeting business. I assume there's not any issue with that, but if anybody has a question or concern. Seeing none, we can move on to Article VI. Again, some minor changes to clarify the language of business. Section 1, standing committees, we also added and/or deaf-blind people, that seems to be omitted from the language of who we serve.

Section 2, Task Forces, we wanted to be more clear about the fact that as a Council we can appoint, establish, add task forces, committees that have specific temporary business, especially if it's an urgent issue, like bills pending and stuff like that that we would like to address in a hurry, so we can appoint people to group together and work on those. Members of task forces are represented also on the executive committee for the term of the task force.

Section 3 and 4, reworking some of the language to be a little clear. Again, proposing that if we have a vice-chair, that vice-chair would be kind of responsible for overseeing the work of the committees, making sure people have what they need, helping with participation or any questions or concerns and that I believe covers all the proposed changes that we are making to the bylaws. Any questions or concerns so far? My understanding now we will be sending this out to everybody and you will all get to review it and be prepared to either propose any changes you see necessary. At the August meeting, assuming we have the majority we need, we will be voting on the changes to the bylaws.

Communication Access in Healthcare: Next Steps

Jan Withers, Director, Division of Services for the Deaf and the Hard of Hearing

Mark Benton, Deputy Secretary for Health Services, Department of Health and Human Services

Jan Withers:

This topic is something you the Council have been monitoring and had concerns about for quite a long time, and the topic is Communication Access in Healthcare. You all have invited individuals to come and present to the Council. I have presented to you about this very subject, and all of you are aware of several activities that have been going on over the years.

To address the training for people in healthcare, we have a self-advocacy training for the Deaf. There are funding issues for sign language interpreters that you all are concerned about. It's kind of like a puzzle with different parts. Healthcare is complex and North Carolina is a very large state. I am thrilled to tell you that I am starting to see the most important parts of the puzzle starting to come together.

I mentioned at the February Council meeting that I shared with the new administration Secretary Cohen my top three goals for the first 100 days of the administration, and I'm happy to share with you that I successfully accomplished two of the three, which exceeded my own expectations.

• Get approval for Assistant Director –

- We are in the process of making those interviews.

• Hire a Project Manager for new database system

- We have hired someone for the position.

• Having a partner on the Health side of the Department of Health and Human Services

The Department of Health and Human Services has about 18,000 employees, and there are two sections that make up the department. There's human services and health services. The human services side involves services such as DSDHH, DSB, VR services, social services, child development and others. The health section includes divisions like public health, Medicaid, mental health and so forth. Traditionally they are separated, more people are noticing that when we pull in human services and connect them with health services we see a positive impact on the client's health. I'm happy to say the Secretary has recognized the importance of the partnership between two human and health services working together and that’s working well with communication access, a human service. This can have a tremendous impact on the individual's health. I’ve had the pleasure of presenting to Secretary Cohen two months ago, and the topic presented was the need for a communication access improvement in healthcare. I suggested a partnership with someone on the health side to help me navigate the complexities and the healthcare structure and their infrastructure, and connect me with all the right individuals to help me work towards enhancements in communication access and healthcare, I'm thrilled to say that I do have a partner now and that is Deputy Secretary Mark Benton. It is my pleasure and my extreme honor to introduce Mark Benton to the Council to talk about this important work.

Deputy Secretary Mark Benton:

Thank you very much for the opportunity to be here today to speak with you, and meet with some individually. I’ve had the pleasure of working in the department now for about 20 years. I have a broad portfolio underneath my responsibilities I have, our state's mental health system. I have our state's public health system. I'm also responsible for rural health and physician recruitment efforts. I also have our Division of Health Services Regulation and lastly I have responsibility for all 14 of our state facilities. That includes our three state psychiatric hospitals as well as our developmental disability facilities as well as some of our long-term facilities around the state and I am thrilled to be partnered with Jan and better help the work that Jan and you and others have been working on throughout the years. Some of the things that we hope to do is to meet monthly and discussed how some of the relationships that I have on the health side of the House, particularly with our physician community, can better help the work that you all and she and her Division are working on. Relationships we're working on right now are doing better introductions or new introductions to our local health departments, our North Carolina Pediatric Society, our North Carolina Academy of Family Physicians, the North Carolina Hospital Association, as well as the North Carolina Institute on Medicine. Some of you may have read in the paper or seen on our website that we are undertaking another effort of reforming our Medicaid program. Jan has been in those discussions with two very key people involved in that effort. Our current state Medicaid Director, Dave Richard, as well as Angela Diaz looking after the Division of Health Benefits, which once Medicaid reform is up and operational, she will be part of the new Medicaid agency going forward.

One of the things that Jan and others are working on is trying to make sure that whatever is designed for Medicaid, is receptive to the needs of our deaf, hard of hearing and deaf blind population. A lot of work has been taken over the past several years how we can have Medicaid begin reimbursing sign language services as a covered service under Medicaid. I will share two things, first is when Medicaid managed care is up and operational and that date is tentatively scheduled for July 1st, 2019, it will be a requirement that every Medicaid Managed Care Organization will cover sign language interpreter services, regardless of setting from that date forward that's a good and positive development. Between now and 2019, our state Medicaid Agency that is led by Dave Richard is in the final stages of doing the financial analysis of what it's going to cost to bring this particular service under the Medicaid program right now, and our hope is in the new state fiscal year, once that work is complete, the new state fiscal year begins in July that we will submit the required paperwork to CMS, the federal oversight agency for Medicaid, to get the necessary approval from them to be able to cover that service more quickly before 2019. Those are two good developments.

Jan has certainly lent her voice to what is needed moving forward, Claudia Horn has also been talking with the department about how that program should look moving forward. I would like to encourage all of you to take the opportunity to let the department know what you believe this Medicaid program should look like going forward and you will have several opportunities to do this. This coming Tuesday there will be a public hearing held here in Raleigh at the NC State Campus, at the McKimmon Center from 6:00 to 8:00. I hope you will go and lend your voices there. If that's not a possibility, I encourage you to submit your comments in writing and send them to me at the Department, send them to Jan at the Department or go on to our website and there's an opportunity there that you can submit comments online. It's important to hear from a variety of individuals, folks both on Medicaid, not on Medicaid about how we want this program to look and operate going forward.

I would also encourage you to do is as you think about your comments and how the program should look, one thing we need to hear about is when we go and look behind with the managed care companies to find out how well they're providing services to the deaf, hard of hearing, deaf-blind population, how well are that ensuring interpreter services are available in all settings, what kind of measures or goals should the state be looking at and apply to these managed care companies so we know they're doing the job we need them to do going forward.

Jan and I meet monthly, and that's really part of an ongoing conversation and work that Jan and others are doing around education and training and outreach, I wanted to also let you know about some of the things that she and I are talking about now, and that is how we may be able to better leverage our physician training and hospital associations, and also I wanted to draw your attention to an article that some of you may have read that Jan authored in the North Carolina Medical Journal. It is an incredible read, and I encourage you to look at that. These are some examples of outreach and training that Jan and others have been working on. I thought it would be helpful to share an exciting new project that Jan has shared with me that we hope to get started in the next couple months, it's particularly about our work with public health and more specifically about sort of examining the link between those that are deaf or hard of hearing who may also have diabetes and dementia and connection to falls. We think this is an incredibly important work for the Department, whether Medicaid or more broadly, across those who do and do not have Medicaid. Hopefully there’s more of that to come.

In conclusion, I just wanted to also share with you that the Secretary and I got the letter the Council wrote this past March. She and I have read it and talked about it several times and believe there is a lot of opportunity where we may be able to do more. She will be visiting this Council at your next quarterly meeting to talk more specifically about some ideas that you may have for her. She is keenly interested in making sure that people have access to healthcare.

I hope that you will use your time with her to talk about the issue of the uninsured within your community and how the state may better address that issue and particularly for those that may be uninsured, how do we make sure that they can have access to free or affordable sign language interpretation services. There have been ideas that have been shared about developing or starting up a communication fund. I think that would be a wonderful opportunity to let her know about those ideas about how we can sort of address the uninsured as well as for those who need access to sign language interpreter services.

I know that she will enjoy her time with you and you will make her feel welcomed as you did me. I very much appreciate the opportunity to be here. I hope it won't be my last and you'll invite me again. Thank you for the opportunity to be here. Thank you very much for the work that you do every day.

Study: The Experiences of Deaf North Carolinians in Accessing Healthcare

Glenn Silver, Program Planner/Evaluator, DSDHH

This morning I'm going to give you an overview of where we are on some research that we've done to support some of the efforts that Deputy Secretary Benton just talked about. Providing Medicaid reimbursement for interpreter services. The purpose of the needs assessment on communication access in healthcare settings is to demonstrate to policy makers in North Carolina’s healthcare infrastructure (public and private) that barriers to effective communication in healthcare settings exist for deaf people who rely on American Sign Language (ASL).

The Rationale for the Project

• The challenges faced daily by deaf ASL-speakers are poorly understood, if at all

considered, by healthcare policy makers and providers.

• Provides impetus for North Carolina’s healthcare policy makers and providers to partner

with DSDHH in developing and implementing solutions, resulting in effective

communication between healthcare providers and Deaf patients.

The Target Population

• Deaf North Carolinians who rely on ASL as their primary language and therefore need

Sign language interpreters as an accommodation in face-to-face communication with

their healthcare providers.

• Does not include deaf-blind, hard of hearing, or late-deafened North Carolinians.

• Hard of hearing and late-deafened people who sign fluently and rely on sign language

interpreter to achieve effective communication in healthcare settings may participate in

the needs assessment.

• Results might be used to provide guidance on future needs assessments that address

the communication barriers for deaf-blind, hard of hearing, or late-deafened North

Carolinians.

The Desired Outcomes

• Healthcare providers are aware of barriers to effective communication.

• Healthcare providers are receptive to participating in activities that successfully achieve effective communication.

• Healthcare providers know where to obtain appropriate resources to achieve effective

communication.

• Healthcare providers engage in activities to achieve effective communication.

• Communication Access Fund is established.

To get these outcomes, there are specific things that we are doing and have done and plan to do. One of them is we've done the literature review, that's been done in a study about what’s already out there, what’s going on in other states, what research is out there to support this. A study has been done, Dr. Wax has completed that study where a health satisfaction survey was done that included providers from the Division of Vocational Rehabilitation services and one of the providers of mental health services, RHA, and included members of the North Carolina Chapter of the Hearing Loss Association of America and North Carolina Deaf Blind Association. Quantitative survey research was done and a draft report has been prepared. The report indicates, people do report communication barriers to getting healthcare, being able to have effective communication is very inconsistent. This can cause people to throw up their hands and say I'm not going to go to the doctors or get healthcare.

The next part is to translate the survey research that already has been done, to have it in American Sign Language, so that the people that we serve at the DSDHH can participate, we can get their information. One of the things that some people in the hearing population don't understand, that American Sign Language (ASL) is a language, it's not a translation of English. So, we want the mode of communication that our consumers prefer that we can offer this survey in their preferred mode of communication. The next step after we get that quantitative part finished we are scheduling some forums that we want to go out and do. We want three forums in each region of the state. The western, central/piedmont, and the eastern, where we will invite people who are deaf, and we're not going to exclude people who are hard of hearing and others who may show up. We have researchers from Gallaudet University and the University of North Carolina at Chapel Hill from the Sheps Center, co-principal investigators. So, we can have a robust study and hopefully publishable results so that when Secretary Cohen and Deputy Secretary Benton want to make a presentation or want to make their case with legislators or other policymakers, private industry, that they have something to rely on that is very reliable and makes the case. This is something that is a real issue and needs to be addressed and it will benefit everyone.

Last year, I did a presentation of the economic impact of hearing loss, and what we did, just briefly to summarize, we took a model of economic impact analysis that was done by some researchers in North Carolina State University and we applied it to the growing number of people with hearing loss in the state. What an economic impact analysis does is it says that it’s okay if I have a job, then not only does my job put money in my pocket, but when I go to the gas station, it helps pay for the salary and the wages of the people that work in the gas station and then if I buy something off the counter, it pays for the vendor that brought that product, and it trickles down, it's a ripple effect. When we look at the economic impact, the potential economic impact on employment, one of the things that research has shown is that when people have access to healthcare, they show up at work, they're more productive, they're more likely to move from unemployment to some type of part-time or full-time employment, and from part-time employment to full-time employment.

This has been shown for decades and it's common. Most jobs have preventative health incentives, things to encourage you. This reduces insurance cost, absenteeism and helps make employees more productive. There's a study done in 2011 that showed that when people get access to healthcare, it can increase their likelihood of employment by 3%. When you take that 3% figure and apply it to the number of people in North Carolina who may be adversely affected, the number of jobs that are not filled because people have untreated hearing loss, that reduces that number by 3%.

Tovah Wax: Do you mean general healthcare or general access to communication -- interpreter services.

Glenn Silver: We're talking about this and healthcare. This is for healthcare alone, because that's where the 3% figure comes from, so that's the link between the healthcare and employment, not just all services.

Tovah Wax: If they had access to interpreter services for healthcare.

Glenn Silver: Right, if they had access to services for healthcare. If they had access to services for healthcare that would improve their health which would improve their employment. That's the model in the assumption, and that's based on research done in 2011.

Kathleen Thomas is from the Center at the University of North Carolina at Chapel Hill and she's done work in the past on Medicaid and how it affects your likelihood for employment and she’ll briefly tell you about this. Dr. Kathleen Thomas is working with us and Mark Myers from Gallaudet University on the research for the forums I mentioned to you in the three parts of the state.

Kathleen Thomas: Thank you I'm pleased to be here. When we did this study and the findings will not be surprising to you, but what we found is that when people have flexibility in how they use their healthcare services, they could either go regularly or have a visit and then a long creative time where they were working or doing whatever and then go back, that they were more likely to be employed. This was just a small effort to try and document some of the pieces that need to be in place to support employment. I'm pleased to get to be a part of this project now.

Glenn Silver: Thank you very much, Kathleen, for explaining it for us. This is part of a body of research. Questions.

Timothy Boyd: What is the impact around patient privacy; do the interpreters need to have some type of additional sensitivity training or additional certification on top of their translation services.

Glenn Silver: Yes, that is the point that Dr. Tovah Wax was making, and Jan can probably address that more than I can, about what those specific requirements are, but it would be different for some of those reasons. I defer to Jan. She can elaborate on that.

Jan Withers: Here in North Carolina, interpreters must be licensed to be able to work in the community if they are doing interpreting for pay. Interpreters must adhere to a code of professional conduct, one of those requirements in that code is confidentiality. Any interpreter that receives training as an interpreter understands that it is one of the top priorities. Interpreting has a strict adherence to confidentiality. Interpreters also receive basic training that can be applied to healthcare settings up to a point. If there is a healthcare appointment or a situation that is beyond their qualifications, then again they would have to rely on their code of professional conduct and adhere to it. The conduct requires them to recuse themselves from that assignment if they're not qualified to interpret for that assignment. We are planning to develop training, bring in experienced people to North Carolina to provide training specifically for interpreters in healthcare settings. Unfortunately, there was an entity that was providing healthcare training in medical settings but there is not a specialist certificate for interpreters to get from our professional organization regarding healthcare. There is one for legal but not in healthcare settings.

Timothy Boyd: There's no existing healthcare law that is going to put an interpreter at risk for being sued or something like that because it's in a privacy setting.

Tovah Wax: Confidentiality is a code of ethics issue for interpreters as it is for many professions. The issue of being sued will probably be more likely to arise in terms of the expertise of the interpreter. If the interpreter doesn't understand the medical terminology or what the doctor and patient are talking about, that's more likely to be a case for where an interpreter might be sued for competence in that area, and that's the issue that needs to be addressed in terms of qualifications of the interpreter for interpreting in those settings, the ethical conduct for confidentiality is well covered for both interpreters and the providers.

Timothy Boyd: Thank you for presenting. It was very informational.

Reports from Committees

Education Committee

We reviewed information from our previous meeting in February. Our agenda at that time was a letter to follow up with DPI about pre-K services for students who are deaf or hard of hearing. That was a letter approved last meeting and I just handed it to Tovah today for her signature and mailing to DPI. We talked a little bit about the Gallaudet shared reading project and bringing that to North Carolina and how agencies can work together to do that. Also expanding a pool of deaf mentors in the states to help families. Looking data that is being collected by DPI, the data collection that was required through House Bill 317, DPI is founding out information about students across the state and finding pockets maybe using ASL and we can therefore use that data to help us determine where we might set up support systems for families in those locations.

We discussed the Spoken Language Facilitator question that has been something we have been concerned about, and Michelle from DPI let us know that a definition for Spoken Language Facilitator or defined position will be part of the plan moving educational interpreters forward and improving those skills. Part of that will all be rolled into one definition for a Spoken Language Facilitator position and that will all be taken to the State Board of Education at one time so that we're not making small changes, rather one large change, and that's a piece of the puzzle that is what is currently not working well for our students who are using ASL in schools and using interpreters. They're going to move ahead with those changes but it will be at the same time as the educational interpreter improvements.

Community Access Committee

We spoke about the need for hearing screening when there were issues of needing speech, language or cognitive evaluations, having the child or adult's hearing screened first. We talked about the audiological management of hearing loss for adults that could be from medicine. It could be from chronic diseases. It could be from noise, but making sure that adults have their hearing checked. We spoke about issues with hearing aids and Medicaid, that currently hearing aids are only covered up until the child reaches 21 and then they're not covered. They are covered in a skilled nursing facility. As an unmet medical need, but there's a huge gap between 21 and whenever they go into the skilled nursing facility where there are no coverages except for vocational rehab coverages, there's one segment in assisted living that nobody will cover. We talked about Tovah doing a letter to DMA, is that correct?

Tovah Wax: We spoke about the letter to the secretary recommending a collaboration of several agencies around these issues.

Motion: Moved by Kevin Earp and second by Lester Latkowski to write a letter to the secretary recommending a partnership of key agencies involved in hearing screening and hearing aid coverage to revisit the issue of providing support for this population.

Motion carried.

Announcements

The administrative office of Division of Services for the Deaf and Hard of Hearing (DSDHH) will be moving to the Dix campus towards the end of June, and then after that sometime during the summer we will have open house.

On June 22-June 24, 2017th, the North Carolina Association of the Deaf and Registry of Interpreters for the Deaf joint conference will be held in Winston Salem, North Carolina.

Adjournment

Future Meetings: August 11, 2017 NC Joint Force Headquarters

November 17, 2017 Division of Public Health, Building 3

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