ODP Deaf Services Overview Lesson 2 (PD) (music playing) Course Number

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1 (music playing)

2 This webcast includes spoken narration. To adjust the volume, use the controls at the bottom of the screen. While viewing this webcast, there is a pause and reverse button that can be used throughout the presentation. The written version of the narration appears to the right of the screen.

3 Certificates of Achievement will be available to SCs and SC Supervisors after completing all course requirements. Please view and then save or print your certificate in order to receive credit for this course. For SCs and SC Supervisors, course requirements include successful completion of a pretest and a post-test.

4 Hello. Welcome to the course ODP Deaf Services Overview, Lesson 2. My name is Patty McCool. I am the Director of the Bureau of Supports for People with Intellectual Disabilities and I would like to welcome you to this webcast. As you know, DPW recently entered into a settlement agreement in the case of Harry M. versus DPW. This case focused on communication access for people who are deaf and served through the Consolidated Waiver. This training is one part of what is required by the settlement agreement. This training has been developed in two modules. You have already viewed the first module which covered information that all Supports Coordinators need to know. This second module covers activities that are specific to those Supports Coordinators who serve individuals who are deaf. All Supports Coordinators are required to complete both modules in the event that they currently serve or will serve someone who is deaf.

5 Throughout this presentation People First Language will be used. However, be aware that the American and international associations of Deaf and Hard of Hearing adults have endorsed using Deaf or Hard of Hearing first before the person. The reasons for this are that both groups want hearing loss to be known and it emphasizes the importance of the need for effective communication and, in some cases, cultural identity. When working with individuals who are deaf, it is best practice to ask them if they would prefer that you use People First Language such as an individual who is deaf or if it would be preferred that you say a deaf individual. I will now turn this presentation over to a representative from the ODP Consulting System who will be your presenter for this webcast.

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7 You learned a little about the Deaf Services Coordinator position in the first webcast. You also met Maureen Veety, the ODP staff person who is in this role. At this point, we wanted to share some information about what the Deaf Services Coordinator does so that you have a better understanding of Maureen s role and the resources she provides. The Deaf Services Coordinator s focus is on supporting Harry M. class members those individuals who are deaf and in the Consolidated Waiver. She is also available as a resource for all individuals who are deaf and supported by the intellectual disability system, amongst other ODP stakeholders who serve, want to serve, or need information regarding services for individuals who are deaf. ODP and the Deaf Services Coordinator, or DSC, are responsible to identify all current Consolidated Waiver participants who are deaf and individuals who are deaf and on the emergency waiting list. A survey was sent out to providers and SCOs to gather this information last year. This information will be collected in an ongoing way through the new HCSIS field, described in the first webcast in this series. The Deaf Services Coordinator will keep the list up to date. The survey also collected information from providers and SCOs about provider staff and SCs who are skilled in supporting people who are deaf. The DSC will keep this list up to date and will support Consolidated Waiver participants who are deaf in choosing an experienced SC if they would like to do so.

8 The DSC coordinates the communication assessment and re-assessment processes for people who are deaf. All individuals who are deaf in the Consolidated Waiver or in intent to enroll status for the Consolidated Waiver will have initial communication assessments within one year of the DSC start date, which was February 3, The DSC will work to ensure that reassessments occur on the schedule recommended by the previous assessment or sooner if requested by the ISP team due to changing communication needs. The DSC will also monitor the performance of the assessors to make sure that they are completing the assessment as directed by ODP. Once the communication assessment process roll-out has begun, SCs may be asked to give recommendations about which individuals are eligible for the assessment. If the communication assessor feels that the Supports Coordinator is integral in the assessment, the SC may be asked to participate. After the assessment is completed for an individual, the DSC will send the assessment report and recommendations to the SC. The SC will share this assessment information with the team and will work with the team to incorporate the information into the ISP. The DSC will monitor to ensure that communication assessment recommendations are included in the ISP and that supports and services recommended by the assessment are offered. She will also follow-up on complaints that individual class members are not receiving services to meet their communication needs, provide technical assistance as needed, and work to ensure that services and Assistive Technology included in the ISP are provided.

9 ODP and the DSC will set up a system that allows for matching housemates and providers. This includes: Identifying new Consolidated Waiver participants who are deaf and giving them the opportunity, if they choose, to live with other participants who are deaf in a new residential habilitation home or an existing home with a vacancy. Identifying vacancies in homes with individuals with typical hearing and offering vacancies to individuals with typical hearing who are currently residing with individuals who are deaf in order to open a vacancy for another individual who is deaf, if the people in the home wish to move. Working to ensure that county lines do not pose a barrier to placement. Collecting information from assessments regarding individuals who are deaf and who may want to live with others who are deaf, in order to match them with housemates. Recruiting and identifying providers for individuals who are deaf where needed. Assisting SCs to find providers and housemates as needed.

10 ODP and the DSC are responsible for developing and providing training for a variety of stakeholders. You are participating in part of this training right now. In addition to Supports Coordinators, Providers, investigators, licensing inspectors, monitors, and Communication Assessors will be trained. The DSC will also provide technical assistance to stakeholders. For Providers, individuals, and families, this technical assistance includes information on vacancies, Deaf culture, deafaccessible programs, appropriate assessors, assistive technology resources, posting of staff vacancies where people who are deaf are likely to see them, and physical environment adaptations. The DSC will also provide technical assistance to the PA intellectual disability system including setting communication policies and standards, determining the need for training related to individuals who are deaf and in the waiver, and identifying any gaps or barriers to service provision.

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12 This section of the presentation discusses the roles and responsibilities of Supports Coordinators who are supporting people who are deaf. We ll talk about working with sign language interpreters, the communication assessment, service descriptions, and documentation of relevant information.

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14 The Americans with Disabilities Act, or ADA, ensures the provision of equal access for all individuals with disabilities. This law requires that reasonable accommodation be made to allow individuals with disabilities to participate fully in and receive all of the services and benefits available to those without disabilities. In certain instances, it is necessary for individuals who are deaf to have communication assistance in order to receive services and benefits. Communication assistance services can take a variety of forms depending on the needs and ability of the individual who is deaf. Communication assistance for people who are deaf includes the following types of activities: Certified Deaf Interpreters, Staff or interpreters proficient in sign language, Video Remote Interpreting, Assistive technology, such as adapted telephones like captioned telephones and telecommunication devices for deaf persons or TTYs, Communication Access Real-time Translation known as CART or real-time captioning, Access to video phone equipment, Visual supports such as checklists, schedules and materials, Open and closed captioning on TV, and Exchange of written notes. An individual s need for communication assistance can be determined in various ways which include, but are not limited to: an assessment completed by a speech-language pathologist, a formal communication assessment selected by ODP for individuals who meet the criteria for such an assessment, or a determination by the Individual Support Plan team of the individual s need for communication assistance to be provided on an interim basis pending the completion of an assessment. Assessments are very important for determining the long-term needs of participants. The need for an assessment, however, should not delay the provision of communication assistance such as an interpreter for a meeting. For this reason, the service can be authorized in the Individual Support Plan and provided on an interim basis pending the completion of an assessment when the Individual Support Team determines that communication assistance is necessary. Sign language interpreters are one form of communication assistance. In this section of the presentation, we re going to talk about your roles and responsibilities related to coordinating and providing sign language interpreters.

15 Individuals have a right to participate in and contribute to things related to themselves and their lives. If the individual or a family member uses an interpreter to communicate, it s important to have an interpreter present so that the individual is able to fully participate in the discussion. Supports Coordination Organizations are required to provide communication assistance when providing supports coordination services, such as Individual Support Plan meetings and monitoring visits, to all individuals who are deaf. If you are aware that an individual for whom you provide support needs an interpreter for meetings or visits, don t wait for a Communication Assessment to provide a sign language interpreter. When we re talking about providing an interpreter, we re talking about providing a Qualified Sign Language Interpreter, an individual who is state-registered under the Sign Language Interpreter and Transliterator State Registration Act and who engages in sign language interpretation or transliteration. For the purposes of this definition, interpreting is the process of conveying English in grammatically correct American Sign Language and the process of conveying American Sign Language in English. It is not recommended that family members or friends be used as qualified interpreters so that these people can focus on their roles as team members and supporters for the individual. Please note that Supports Coordination Organizations are not responsible for providing communication assistance for any function that is covered in the individual s Individualized Education Plan or IEP.

16 Another resource comes from the Office for the Deaf and Hard of Hearing, the state office that provides advocacy, information, and referrals for Pennsylvanians who are deaf, hard of hearing or deaf-blind, and their families and caregivers. On the Office s website, there is a Sign Language Interpreter Search that can be used to help locate interpreters in your area of the state. A link to the search website is on this slide. You can also search online for PA ODHH Interpreter to find this webpage. Please note that scheduling an interpreter should be completed well in advance of the meeting date. It is best practice to begin scheduling for an interpreter about three to four weeks in advance of the meeting date and to give the interpreter or interpreter service multiple dates and times to choose from.

17 We also wanted to share some resource information with you related to interpreters for Medical Assistance services. When scheduling an appointment for Medical Assistance non-waiver services, individuals or staff who assist the individuals should ask the Medical Assistance provider for an interpreter. If there is difficulty getting an interpreter, individuals or staff should ask for further assistance in obtaining an interpreter. If the individual receives physical or behavioral health services through fee-for-service such as ACCESS, the individual or staff should either send an to or call the Office of Medical Assistance, Bureau of Fee-for-Service Programs at , choose Option #7, and leave a message. If the individual uses a Medicaid Managed Care Organization, or MCO, for physical or behavioral health, the MCO should be contacted for assistance. In the case of physical health, contact the Special Needs Unit of the MCO. If these contacts do not resolve the problem, the individual or staff should contact the ODP Deaf Services Coordinator.

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19 As we talked about earlier in this webcast series, all individuals who are deaf and enrolled in the Consolidated Waiver or in the intent to enroll status for the Consolidated Waiver will have a standardized communication assessment completed within the next year. The assessment will evaluate language skills including the individual s: Ability to sign, speak, read, write, speech read, use technology, and gesture Ability to learn how to sign, speak, read, write, speech read, use technology, and gesture Currently preferred method of communication, and Most promising method to learn.

20 The assessment will also generate recommendations concerning: Staff skills, such as level of ASL fluency, visual/gestural training or other skills that are needed for effective communication now Staff skills needed to improve communication ability Specialized services, environment, or equipment needed to improve communication ability Needed communication assistance at meetings and appointments The timing of the communication reassessment Whether a separate assistive technology evaluation is necessary, and Any other matter the assessor deems relevant. As we said earlier, after the assessment is completed for the individual, the DSC will send the assessment report and recommendations to the Supports Coordinator. The Supports Coordinator will share this assessment information with the team and will work with the team to incorporate the information in the Communication Section of the ISP or other appropriate areas of the individual s support plan.

21 We wanted to provide you with some examples of the kinds of recommendations you may see from the Communication Assessment. Remember, these recommendations must be included in the Communication Section of the ISP. Recommendations may include: What communication methods lead to effective communication with the individual What communication methods are not effective and should not be used with the individual Services for the individual to enhance their communication effectiveness Communication skills such as level of fluency and type that are needed by staff working with the specific waiver participant who is deaf Accommodation recommendations for the individual for interactions with staff and other providers who are not proficient in communication methods identified in the individual s communication assessment Housing recommendations for the individual, including if the individual may benefit from living with others who are deaf Other deaf-specific resources that can be useful to the waiver participant who is deaf or those supporting the individual In-context communication training for staff specific to the communication needs of the individual Recommendations for assistive technology, and Recommendations for opportunities for waiver participants who are deaf and their family and support staff to socialize locally with other individuals who are deaf and communicate like the individual.

22 The timing for a re-assessment will be recommended by the first communication assessment. SCs should record the recommended timing for re-assessment with the other recommendations in the Communication Section of the ISP. The DSC will be tracking reassessment timing as she is responsible for coordinating the scheduling of assessments and re-assessments. She will also be monitoring assessment timing to ensure that assessments and re-assessments are completed within the required timeframes. If a re-assessment is needed sooner than the timing recommended by the first assessment due to changing needs related to communication, the ISP team can request a reassessment. An example of when a re-assessment may be needed is if an individual has a sudden change in health, such as a stroke. This health change may result in changing needs, including those related to communication. In this situation, the individual and the people who support this individual may need to learn new ways to communicate, and the assessment may help them figure out how best to do this. A re-assessment may also be needed if the individual is learning faster or slower than expected. ODP is still working out the details of how the assessment scheduling process will work. More information about the assessment process will be shared when it becomes available. Until this scheduling information is available, Supports Coordinators are encouraged to contact the Deaf Services Mailbox at if they know of an individual who may be eligible for an assessment.

23 This section includes information about the Enhanced Communication Services modifier that is now available for select services. Even though this modifier is new, the typical process for adding supports and services to an ISP should continue to be followed.

24 This slide shows how the Enhanced Communication Services modifier appears in HCSIS for select services. Please note that only individuals served in the Consolidated Waiver can have authorized Enhanced Communication Services. When you search for Enhanced Communication Services to add to a plan, look for the ECS at the end of the service name, which indicates that the service is an enhanced communication service. A screen shot of a search is shown on the slide. The provider s eligibility to provide Enhanced Communication Services will be communicated by ODP. The information provided will tell you what service or services the agency is able to provide under the Enhanced Communication Services and for which locations. Providers who already serve or are interested in serving individuals with enhanced communication needs should contact the appropriate Regional Fiscal Officer to learn more.

25 Procedure code designations for the Enhanced Communication Services will have a U1 modifier included. The U1 modifier is available for all services under the Consolidated Waiver except Homemaker/Chore, Assistive Technology, Home Accessibility Adaptations, Specialized Supplies, Transportation, Vehicle Accessibility Adaptations, and Supports Coordination. The Expected Start Date must be on or after December 14, HCSIS will not allow you to save an Enhanced Communication Services Expected Start Date that is earlier than December 14, 2013, as this is when these services were added to HCSIS.

26 The ISP Manual is currently being revised to reflect changes related to the Harry M. settlement agreement. The proposed changes to the ISP Manual include: 1. Adding a section titled Deaf Services Assessment this section would give a brief description of the communication assessment that will be used for class members. 2. Adding a U1 modifier section to each eligible Enhanced Communication Service in the Consolidated Waiver which signifies that the individual has been assessed as needing this service by staff proficient in Sign Language. 3. Making updates to the Education Support Services and the Speech and Language Therapy section. The updates to the Education Support Services description are proposed to include teaching American Sign Language or another form of communication to an adult waiver participant who is deaf and has been assessed as benefitting from learning American Sign Language or another form of communication. The updates to the Speech and Language Therapy definition are proposed to include consultation regarding the communication needs of waiver participants who are deaf. These updates will outline new services available to individuals related to communication assistance and the teaching of sign language skills to an individual. When the ISP Manual has been revised and reissued, ODP will communicate its availability. Please note that the changes just described are proposed and may change before the ISP Manual is re-issued. The qualifications of providers for each of these services will also be included in the updated manual.

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28 Once an individual who is deaf receives a Communication Assessment, the DSC will send you the information that you need to complete the information in HCSIS, including whether or not the individual is eligible for Enhanced Communication Services. Providers will also need to follow certain steps, including being made eligible for ECS, before the service will appear as one that they offer. SCs should note that all screens must be completed per the Job Aid and Captivate trainings found on the LMS in order for the Enhanced Communication Services or the U1 modifier to be added to the individual plans. SCs who are supporting people who are deaf and enrolled in the Consolidated Waiver are to document information relevant to the Harry M. class members in the ISP Monitoring Tool. If, during ISP monitoring, Supports Coordinators become aware of issues with communication and/or communication supports that are occurring for an individual, these issues should be documented in the monitoring tool and followed up on through the SCO s typical processes. As stated previously, Supports Coordination Organizations should contact the DSC if the Supports Coordinator has difficulty finding a provider to meet a communication need identified in the ISP or the Supports Coordinator becomes aware that a communication assistance need is not being met as specified in the Individual Support Plan. Activities identified as responsibilities of the Supports Coordinator will be monitored through ODP s monitoring of the SCO. SCOs should be aware that items such as completion of this training and the activities outlined under roles and responsibilities may be monitored during the next SCO Monitoring.

29 (music playing) This webcast has been developed and produced by the Office of Developmental Programs Consulting System on behalf of the Pennsylvania Department of Public Welfare, Office of Developmental Programs. Thank you for participating in this lesson. (music playing)

tation DEVELOPMENTAL PROGRAMS BULLETIN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE EFFECTIVE DATE: April 8, 2014 BY:

tation DEVELOPMENTAL PROGRAMS BULLETIN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE EFFECTIVE DATE: April 8, 2014 BY: tation DEVELOPMENTAL PROGRAMS BULLETIN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE DATE OF ISSUE: April 8, 2014 EFFECTIVE DATE: April 8, 2014 NUMBER 00-14-04 SUBJECT: Accessibility of Intellectual

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