ODP Deaf Services Lesson 1 (PD) (music playing) Course Number

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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. My name is Patty McCool. I am the Director of the Bureau of Supports for People with Intellectual Disabilities and I ll be your presenter for the first part of this webcast. Next, you ll hear from Louise Montoya, a Consultant to the Office of Developmental Programs on Deaf Culture and the unique needs of people with intellectual disabilities who are deaf. Finally, a representative from the ODP Consulting System will provide you with information about HCSIS documentation and how to contact the ODP Deaf Services Coordinator.

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6 In August 2013, DPW 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. The first module covers information that all Supports Coordinators need to know. The 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. This training will go over different areas associated with the settlement agreement and information that is important to serving someone who is deaf. In addition to this training, please view the Job Aid for Enhanced Communication Services and complete the related Captivate trainings. An overview of these areas will be covered in this presentation, but additional, important details are included in these documents. We re going to spend a little time giving you an overview of the various activities and timelines in the settlement at the beginning of this webcast. If you d like to review the entire agreement or a summary of the settlement, you can access them using the link on this slide.

7 Some of the requirements that ODP has implemented as a result of the settlement include the following. New data fields have been created in HCSIS to identify hearing status, primary language, and communication skills. More information about these fields is included later in this presentation and can also be found through HCSIS Job Aids and Captivate trainings on the Learning Management System or LMS. A Statewide Deaf Services Coordinator has been hired. You ll hear more about when and how to contact her in a little bit. ODP has worked to identify individuals who are deaf who are served through the Consolidated Waiver or on the Emergency Waiting List and staff who are skilled in supporting people who are deaf. ODP is also required to provide interpreters and communication assistance during meetings. Individuals who are deaf will be provided options to choose Supports Coordinators and Providers who are skilled in working with people who are deaf. Individuals will also be supported to live with other individuals who are deaf if they d like to do this. As of April 2014, ODP is refining the process for providers to use when requesting additional funds relating to increased staff costs due to employing and retaining staff who are skilled in sign language. In this case, the term sign language includes American Sign Language, Sign Language from other countries, such as Spanish Sign Language; Signed Exact English; and a mixture of ASL and signed English; tactile sign; and visual-gestural communication.

8 ODP is also required to establish a standardized communication assessment process for use with all individuals who are deaf and who are served through Pennsylvania s Consolidated Waiver. The assessment is currently being piloted with a small group of volunteers. After the assessment pilot is completed and the assessment tools and procedures are finalized, ODP will be completing a communication assessment of all individuals who are deaf and served through the Consolidated Waiver. The communication assessor will make recommendations including whether a separate assistive technology evaluation is necessary. Pennsylvania s Initiative on Assistive Technology, part of the Institute on Disabilities at Temple University, is a good resource for more information on assistive technology. While individuals who are enrolled in the Person/Family Directed Support Waiver are not currently eligible to receive the standardized communication assessment, they may receive an assessment from a speech/language pathologist.

9 There are training requirements in the settlement for Supports Coordinators, Providers, investigators, licensing inspectors, and monitors. The Communication Assessors will also receive training before they complete communication assessments. The settlement specifies what topic will be provided for each audience. The training content includes Deaf culture, the needs of Waiver participants who are deaf, and the role of the Deaf Services Coordinator. This training is the first piece of training related to the Harry M. settlement. As additional training becomes available for other stakeholders, ODP will communicate its availability through the regular communication channels.

10 As specified in the Harry M. settlement agreement, the topics that will be covered in today s training are: Deaf culture Unique needs of Waiver participants who are deaf The new HCSIS fields and how to complete them, and How and when to contact the Deaf Services Coordinator. I ll now turn the presentation over to Louise Montoya who will talk about Deaf culture and the unique needs of people with intellectual disabilities who are deaf.

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12 Thank you Patty. Hello, my name s Louise and my focus in this webcast is to describe Deaf culture and the unique needs of people who are deaf. I am a child of deaf adults which is know as a CODA. I was raised in a culturally Deaf community. ASL or American Sign Language is my first language and English is actually my second language. In my family, there are two kinds of genetic hearing loss. One is congenital deafness and the other is progressive hearing loss in females. Many of my relatives have progressive hearing loss and I have a cousin and an uncle who are both deaf. My uncle is also diagnosed with an intellectual disability. In my professional life, I am a licensed professional counselor and a certified sign language interpreter. I coordinate and provide counseling and consultation services through Children s Hospital of Philadelphia in the Center for Childhood Communication and the Division of Child and Adolescent Psychiatry and Behavioral Services. I am supporting ODP in implementing of the Harry M. settlement agreement.

13 Before we begin to talk about Deaf culture, let s first look at some definitions. The first definition that is important is the definition of deaf as described in the settlement agreement. The agreement states that the criteria you see on the screen will be used to determine if the individual is deaf. The definition is As a result of hearing impairment, the person is unable to understand or communicate verbal expressions at a level commensurate with his or her intellectual ability, even when wearing hearing aids; or as a result of hearing impairment, his or her primary language is Sign Language. Please note that while other people with communication challenges may use sign language, the Harry M. settlement, and therefore this training, are focused only on those who are deaf or hard of hearing.

14 There are different types of sign languages to be aware of. Every country has at least 2 forms of sign language: a sign language that s native to the country with unique grammar, vocabulary and is not the same as the country s spoke language, and a version of the country s spoken language on the hands. So in the U.S., we have American Sign Language, or ASL, and many ways to show spoken English on the hands. There is Signed Exact English which uses English vocabulary and word order. Pidgin Sign Language then is a mixture of American Sign Language and Signed English. Tactile Sign Language is used by people who are deaf-blind and use sign language to communicate. The person who is deaf-blind places their hands on the signer s hands to feel the hand shape, movement, and location of the sign. Visual Gestural Communication is not a language like English or American Sign Language. It is a communication mode that uses gestures, facial expression, and body language. Often individuals who cannot communicate effectively using either a spoken language like English or a formal sign language like ASL, will be able to communicate more effectively using natural gestures. Examples of natural gestures may include extending an open hand with the palm up to indicate give me and pointing to yourself to communicate I, me, or mine. These gestures are generally understood by people within a shared culture and setting. Individuals may also use idiosyncratic gestures. These are movements used consistently by an individual to signify a particular meaning. These gestures are usually understood by familiar communication partners, but may or may not be understood by people who are not familiar with the individual s unique communication.

15 There is some jargon that you may have heard that s important to understand. When you see the word deaf with a lower case d, that refers to people with bilateral severe to profound hearing loss. When you see the word Deaf with a capital D, it also refers to people with bilateral, moderate to profound hearing loss, who identify themselves as part of the American Deaf community and culture and who prefer to use American Sign Language to communicate. Hard of hearing, or the abbreviation HH, refers to people with uni- or bilateral, mild to profound hearing loss, who use speaking, lip-reading, and listening for communication. Hearing loss refers to a decreased ability to hear. Oral or oral deaf refers to people with bilateral, severe to profound hearing loss who use speaking, lip-reading, and listening to communicate. Hearing refers to the category most of you are in. This is the label that deaf and hard of hearing people give to people with typical hearing which is also known as normal hearing. This is a very important cultural understanding for all of us to have. From the deaf person s point of view, the world is divided into deaf, hard of hearing, and hearing people.

16 Let s take a minute to talk a little bit more about language. During the portion of this webcast that I ll be presenting, I may say deaf person rather than a person who is deaf. This is because deaf people prefer this language to people first language, like a person who is deaf. 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. It is best to always use People First language, such as an individual with deafness or a parent with a hearing difference, the first time you meet the individual or family. As part of your conversation with the individual and family, ask them how they would like you to refer to people who are deaf and then use this language moving forward. We recognize that language can be a very individual experience and we need to be respectful of the individual s preferences.

17 There are two different views of deafness or hearing loss. The first view is the oldest viewpoint. It s known as the medical/pathological view of deafness which takes the stance that deafness or hearing loss is a hearing disability. However, a cultural view is that deafness is a language or a communication difference. Let s take a moment to think about deafness as a communication difference.

18 One interesting thing about growing up in Deaf culture in the 1970s was living through the 100 year war between oral and manual communication. This war was between the professionals in the educational and medical communities and those in the Deaf cultural community. What these groups struggled about, and some still do today, was that what was the best way to communicate and educate a deaf or hard of hearing child and person. Oralists argued that deaf people can and should learn to talk and read lips and that learning sign language should be discouraged. Manualists, or those who embrace Deaf culture, argued that sign language is the right of every deaf person and the best way to provide full accessible language to deaf people.

19 As you were listening to the story about the oral-manual war, did you increase the volume on your computer? Maybe you thought that there were some technical issues or some of you may have heard a cough or other noises. What happened to your understanding when we heard those noises? My guess is that you may have been a bit frustrated as my voice became more muffled and harder to hear. Imagine if this was how things sounded to you every moment of your life every day, seven days a week, 365 day a year. Now let s listen to that again without the distractions and at typical volume. One interesting thing about growing up in Deaf culture in the 1970s was living through the 100 year war between oral and manual communication. This war was between the professionals in the educational and medical communities and those in the Deaf cultural community. What these groups struggled about, and some still do today, was that what was the best way to communicate and educate a deaf or hard of hearing child and person. Oralists argued that deaf people can and should learn to talk and read lips and that learning sign language should be discouraged. Manualists, or those who embrace Deaf culture, argued that sign language is the right of every deaf person and the best way to provide full accessible language to deaf people. Let s finish our discussion about the oral-manual controversy.

20 This major difference of opinion has followed me my entire life. Currently it still exists, however there are more people like me who are supportive of all communication and educational methods for deaf and hard of hearing people where the most important factor is that communication be effective and effective most all the time. This usually is different for different people. The differences are okay as long as they really work. There are more people today who prefer one method or another, but are very respectful and supportive of all communication methods as long as the communication for the person with us today is clear to them and we can understand them clearly today as well.

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22 So how was it watching the video? Did you have any idea what I was saying? What kind of feelings and thoughts were going through your head as you watched my video? Well, here s what I said. In my family, there were many times when a deaf family member would go to an appointment not knowing whether an interpreter was really there, wondering if the staff would remember that they couldn t hear, while they sat and waited for their name to be called which doesn t work by the way for deaf people. Then when they finally go up to the desk, usually the interaction was awkward and not easy. A few weeks ago a friend of mine and I attended a conference about deaf people and she didn t know sign language. There were many times for her when things were awkward and not comfortable. Interaction wasn t easy for her.

23 Now, think about what the Titanic learned about icebergs. Only a small part may be apparent, you may not know where it s going to become a big issue, best if we learn to navigate around it thoughtfully. Hearing loss always has a greater effect than is apparent as you can t always rely upon reports by individuals, staff, family members to determine the level of effective communication. Most likely you were a bit frustrated when the volume about the oralmanual wars changed. You may have been a bit frustrated when I asked you what the signs on the previous slide said. Lack of clear communication is frustrating to everyone, especially people with communication challenges, including a person who s deaf, hard of hearing or deaf-blind. A person who cannot communicate may display what we would call "behaviors due to years of not being understood or not being able to express their thoughts, feelings, or needs. Keep in mind that any amount of hearing loss can make a difference. Just because it s a small hearing loss doesn t mean that the hearing loss has a little impact. Much of the information in this training will also be helpful to you if ever work with a family member who is deaf. You may be in the situation where you are supporting an individual with typical hearing who has deaf parents or other deaf family members.

24 So you may be wondering is there really is such a thing as Deaf culture. Yes, there is. The next section of the webcast provides an overview of Deaf culture and as with differences between two cultures, the differences between the hearing and Deaf cultures can lead to cross-cultural conflicts or confusion.

25 Deaf culture is similar to a minority group. Many deaf people view themselves as a cultural minority group which is a key difference from other people with disabilities. For most people in the Deaf culture, the culture is learned from others who are deaf rather than from their family of origin. For adults in Deaf culture, their deaf friends often serve as their family or extended family in place of their biological hearing family. The deaf person s social life and friends often revolve around other deaf people. Deaf individuals tend to marry other deaf individuals as they can communicate with one another. Many deaf adults are proud to be deaf and even some are happy to have a deaf child.

26 There are deaf clubs, churches and temples, socials, websites, arts. There is the National Association of the Deaf, Pennsylvania Society for the Advancement of the Deaf and the American Society for Deaf Children. There are also deaf universities such as Gallaudet University.

27 As one would expect, there are different customs or values in Deaf culture in comparison to the hearing culture. One difference is that brevity and punctuality are not valued. Another difference is that a hug is a culturally normal greeting for hello and goodbye and a typical deaf goodbye might last an hour. At a deaf social function, it s customary and considered polite for you to personally let every person know at the gathering that you re now actually leaving for real! You re not off in the bathroom. You re not in another room of the building. You re leaving and social farewells are expected for each person. So if you re at a large gathering this can definitely take some time. So I ll do some backward planning for the time I actually need to depart and then decide when I need to start saying my goodbyes. If I dare leave early without proper goodbyes, the assumption is that I had an emergency or I m rude, or I think I m better than everyone else, or just socially unskilled.

28 Another value is that things don t typically start and end on time and always last longer than expected. This is often referenced as deaf standard time. One great example I can share is the difference between attending a culturally Deaf conference versus a conference for audiologists. Whenever I attend a conference for audiologists, each session starts promptly on time. Each session is choreographed precisely. The slides, microphone, lighting, all seem to work fine each time. On the other hand, when I attend a culturally Deaf conference often the sessions will not start on time, logistics are still being figured out at the start of the session, and truthfully there are a lot more logistics to figure out when an conference involves speakers and audience members who have typical hearing, are deaf or hard of hearing. Finally, gentle touch is very important in Deaf culture as is sharing intricate details of routine life.

29 Deaf culture also has its own unique language which is ASL or American Sign Language. ASL is a visual language that uses hand shapes, location in space, speed, and size for adjectives, adverbs, verb tenses, subjects, and objects. ASL is not English. It is a full language that is completely different from English. There is also no written form to ASL which means that it cannot be written out and literal translations do not work. For example, in English you might ask, Have you been to the doctor yet? A literal translation into ASL would be Touch finish doctor you? Literal translations between English and ASL are just not possible. If the interpreter you are using is speaking what the deaf person is saying in a confusing way, it may be that the interpreter is not fluent in ASL and may only be giving you a word for word literal translation of what the deaf individual is saying. This is not interpreting between two languages. This is a problem with the interpreter. In ASL, the signs touch finish are correctly interpreted into English as Have you ever or Have you been? or Have you ever experienced?

30 When interacting with people in Deaf culture, there are some terms to use and some to avoid. It s best to avoid the use of normal hearing. Instead, say typical hearing. Avoid the use of the term oral deaf. Instead, use speaking, listening and sometimes technology. Avoid saying hearing loss and instead say hearing difference if you are in a culturally deaf or mixed group. The preferred reference by adults with hearing differences is deaf or hard of hearing person. You may recall I mentioned that I work at the Children s Hospital of Philadelphia where I frequently work with deaf and hard of hearing children and their families. The preferred reference by parents of kids with hearing loss varies, depending on the parents perceived identity for their child. I will listen to how the parent describes their child s hearing difference and I ll be careful to use that same language with that family. Some parents prefer the People First Language, such as child with hearing loss, child with deafness. Some are upset by the words hard of hearing, hearing loss, or deaf, depending upon how the parent s emotional adjustment to their child s permanent hearing difference is.

31 Deciding how a child with hearing loss will communicate, speaking and listening, with or without sign language, and whether they ll use hearing aids, FM system or cochlear implants are usually very difficult decisions for parents that they have to make early in their child s life before age 3, and preferably earlier than that. Cochlear Implants or CIs have only been approved for use in children since Not all children are eligible for a cochlear implant. Only children who cannot understand spoken communication even when they wear hearing aids are eligible for CIs. Not all families choose hearing aids or CIs for their kids. Some families find their child does very well using American Sign Language and will embrace ASL for their child. Unfortunately, the majority of these families do not become skilled enough in sign language to have more than a basic, routine communication with their signing deaf child. So, we cannot assume that the amount of communication parents have with their deaf children actually shows us how much the child can truly communicate.

32 There are a few other general characteristics to be aware of in regard to Deaf culture. Most deaf people cannot read lips and only about 30% of the English language is visible outside of the mouth on the lips. Also, many deaf people do not read or write English well and therefore, do not communicate well in writing. People who are deaf are often highly attentive visually. For example, many deaf people pay great attention to facial expressions. Therefore, when interacting with people who are deaf, be aware of your facial expressions and body language. It s also helpful to smile frequently and show a friendly, caring face often. Hearing technology is any device that helps a person who is deaf or hard of hearing to hear better. This technology includes hearing aids and cochlear implants. Some people who are deaf or hard or hearing may use this type of technology and find it very beneficial. Others may not like this technology and have no desire to include it as part of their lives.

33 Now, let s move from thinking about Deaf culture in general to thinking about supporting someone who has an intellectual disability and is also deaf. The first thing that comes to mind is that most likely the individual does not use ASL fluently. This is known as dysfluency or being dysfluent in ASL. Some deaf individuals with intellectual disability will use nontraditional communication which is known as Visual Gestural Communication. This means that they use natural gestures, acting it out, facial expressions, and actual objects. It would be essential for you as a Supports Coordinator to seek out people who communicate well with the individual. This type of information should be captured in the Understanding Communication section of the ISP. The communication chart captures information about verbal and non-verbal communication, what it means, and what supporters should do in response. As you know from your work supporting people with intellectual disabilities, there is often a smile and nod syndrome if the individual does not understand something. This is true for the individual is also deaf. Therefore, avoid asking yes/no questions and instead ask openended questions such as those that begin with how, what, which, or why. If this isn t successful, change the question to a multiple choice format supported with visual cues offering the right and wrong answer to see if the individual can identify the right answer and demonstrate his or her understanding.

34 Very often, the quality and clarity of communication with an individual is overestimated. People working with an individual, including Supports Coordinators and Providers, may make assumptions about the individual s communication. People may assume that the individual can t communicate or isn t capable of learning to communicate when the individual actually needs to be supported in improving his or her communication skills. Staff may think that a person is able to communicate competently when actually the individual is only able to communicate basic needs or a few signs and communication could be improved with the right supports. Supporters may be surprised to find out when the individual is interacting with those that understand his communication that he could talk all day.

35 Also, if the individual has had periods in his or her life where he or she was not regularly around people who communicate fluently in sign language, ASL or visual gestural communication, the individual s communication skills may atrophy over time. They may lose the skill to express choices, wishes, or preferences. It may take time to bring back or fine tune lost communication skills and establish the idea that the individual can make choices and requests. Individuals who are deaf may require regular trips to their ear, nose and throat doctor for frequent ear wax removal and treatment of frequent ear infections. Regular trips to the audiologist and other medical providers may be needed for evaluating hearing changes, replacement of earmolds, equipment adjustments, and repairs.

36 When you call the individual, you may need to use a telephone or a video relay service. Most likely a deaf individual or family member will have a video phone. In this case, you can dial the number they give you directly. Your call will be routed through a video relay service. An ASL interpreter will answer your call and ask if you are familiar with video relay service, educate you briefly if needed, then place the call to the deaf person. When the deaf person answers their video phone, the ASL interpreter will interpret into spoken English what the deaf person says, and interpret into ASL what you re saying. If the deaf person is not available at the time of your call, you can ask to leave a video message by simply saying your message and the interpreter will send a video message to the deaf person. If the individual has a TTY, a special telephone for the deaf where the caller types and reads what is said, then you can call the deaf person by dialing 711, pressing the number for a voice call, then a relay agent will come on to ask for the TTY number you are calling. The relay agent will type everything they hear from your end and tell you everything the deaf person types. Both services are free, and available 24/7, and are required by federal law to be confidential. There is a link to a short video about how to use the telephone relay system works on the slide. Please take a moment to view this video if you re interested in learning more about how the system works.

37 When you re meeting with an individual, family member, or anyone who is deaf or has a hearing difference, there are a few things to keep in mind that may help the meeting go smoother. The first thing to do is to allot for is enough time. As you will want to ensure clear communication between you and the individual who is deaf, it may take more time to communicate due to the need for the interpreter whether using a paid interpreter or a person who communicates well with the individual. The communication will go more slowly than hearing people are accustomed to. There s no way around this; it is what it is. By allowing extra time, you ll ensure that the meeting goes at the right pace for the individual. The other thing that might happen is if the individual is able to communicate more effectively with the interpreter, there may be a lot more information to share.

38 Do your best to meet in a room that is quiet and well-lit, and close the door if the individual is comfortable with that. It is best to seat the deaf person with their back to the window so they don t have a glare when looking at people. These actions may help the individual who is hard of hearing understand the conversation better. Create a visually friendly meeting space by sitting the group in a circle or with the tables shaped in a U or V configuration. Sitting around an oblong or oval table is not visually friendly it s not easy to the see the face of every person at the table.

39 Also, do your best to ensure that only one person talks at a time. This is a good guideline to follow in any meeting, but in this situation it will help ensure that the individual who is deaf knows who is talking and allows the interpreter to focus on who is talking. It may be helpful to have the person who is talking hold a visual cue like a cup or a special item to indicate that they are talking. It s also customary to raise one s hand when you have something to say. This promotes good turn taking and allows for a split second for the deaf individual to shift their eyes to the new speaker. This may also help prevent multiple people speaking at the same time. If you re working with an individual who uses hearing aids and they re comfortable with it, it s a good practice to make sure you face the person when talking with them and be only about three feet from them. As you would during any meeting, be sure to direct your conversation to the individual whether or not you re using an interpreter.

40 You, the individual, and the team may or may not have experience with interpreters. There are different types of ASL interpreters such as, a Deaf Hearing Interpreting team, Certified Deaf Interpreter and Hearing Interpreter. The type of interpreter present will be based upon the individual s communication needs. Keep in mind that interpreters will interpret everything that is said by anyone in the room. Meeting participants should be reminded to talk one at a time and to make sure that the interpreter is able to interpret everything that is said. If the individual is not familiar with using an interpreter, practice beforehand may be helpful. Practice with the individual what will happen when the interpreter is present such as showing where the interpreter might sit, that he or she will only be there to interpret and not contribute to the conversation. Usually the very first thing that happens in a meeting with interpreters is deciding the best place for the deaf individual to sit and where the interpreters will be situated. It is important to do this first before moving ahead with talking to make sure that the deaf individual is included in his or her meeting. Additional information about working with interpreters is in Lesson 2. I ll now turn this presentation over to a representative from the ODP Consulting System who will be your presenter for the rest of this webcast.

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42 As part of the settlement of this lawsuit, DPW agreed to add mandatory data fields to the Home and Community-Based Services Information System, or HCSIS, to allow Harry M. class members to be identified and tracked through the system. The system is also able to identify and track individuals eligible for enhanced communication services, as well as add and bill for those enhanced communication services. To facilitate this change, enhanced communication service indicators have been added to HCSIS, and changes have been made to the fee schedule and residential rates.

43 We will be sharing some basic information about the HCSIS changes in this webcast. However, there is more detailed information available through the HCSIS Learning Management System, known as LMS. Use the link on this slide to access HCSIS and navigate to the LMS. You ll need to log in using your LMS ID and password. After you log in, navigate to the ODP Enhanced Communication Services course. This course contains the Enhanced Communication Services Job Aid and Captivate trainings. These items will need to be completed in addition to completing this training. If you would like to pause this training now and complete the LMS training, please feel free to do so.

44 Under the Harry M. Settlement Agreement, ODP was responsible to add a mandatory field in HCSIS to indicate whether an individual is deaf based on the criteria indicated previously. As a result, the Harry M. litigation checkbox was created on the demographics screen. Individuals who were identified as class members at the time of signing the settlement had the box automatically checked on December 14, This box is to be used to identify any individuals who are known to be deaf, per the agreement, and those who you think may be deaf. The check box will be used to assist in determining who needs to have a formalized communication assessment. Minor changes have also been made to the Secondary Diagnosis page. The Secondary Diagnosis of Deaf/Hard of Hearing has been split for ODP purposes. Instead of just Deaf/Hard of Hearing, users have the option to select Deaf - ODP, Deaf - can not communicate verbally, or Hard of Hearing - ODP. This allows ODP to identify the specific types of deafness outlined in the agreement. Under Other Non-Medical Evaluations, you have the ability to select the Deaf Services Assessment, which refers to the standardized communication assessment that will be administered to class members. This screen will allow you to record the date, time, assessor s name and if it was found that a person was in need of Enhanced Communication Services. Enhanced Communication Services are services that currently contain the U1 modifier. Supports Coordinators will be responsible to update these screens. Let s take a look at a few screenshots to show us what these changes look like.

45 This is the new Harry M. Litigation checkbox that has been added to the demographics screen. If an individual is identified as being deaf or may be deaf, the Harry M. Litigation checkbox should be checked. This box is being used by ODP to track individuals who are a part of the Harry M. class. When we say a person who may be deaf, we mean individuals for whom the team has reason to believe that the person is deaf or has a significant hearing loss. In addition, individuals who are deaf or may be deaf must be identified by using the other areas currently available in HCSIS as part of demographics. One such place is on the Demographics screen. Here the primary language should be Sign if appropriate. The Primary Language of Sign should be updated for all individuals receiving services through the ID system whose primary mode of communication is one of the following : American Sign Language (ASL) Mixture ASL & Signed English Sign Exact English Sign Language from Other Countries Tactile Sign, or Visual-Gestural Communication. More information regarding these categories will be explained in a moment.

46 Here is the Diagnosis screen we talked about a few minutes ago. For individuals who are deaf or hard of hearing, select the Additional Diagnosis Category of Sensory. In the Diagnosis Description field, select one of the following: Deaf Unable to Understand or Communicate Verbal Expressions - ODP Deaf ODP, or Hard of Hearing ODP. Deaf Unable to Understand or Communicate Verbal Expressions - ODP is used when the individual, as a result of a hearing impairment, is unable to understand or communicate verbal expressions at a level commensurate with his or her intellectual ability, even when wearing hearing aids. Deaf - ODP is used when, as a result of a hearing impairment, the individual s primary language is Sign Language. Hard of Hearing - ODP is used when an individual has uni- or bilateral, mild to profound hearing loss and uses speech, lip-reading, and listening for communication. Supports Coordinators should use information gathered from the ISP team, medical evaluations and reports, and other available documentation to determine which diagnosis description to select. The description that states Deaf/Hard of Hearing without the ODP in parentheses behind it is the old description that is currently used by other program offices. Supports Coordinators should avoid using this description as the others, with ODP as part of the description, should be used instead.

47 An individual who is Eligible for Enhanced Communication Services must have one of the following Primary Modes of Communication indicated on the Communication screen in the ISP: American Sign Language - ASL Mixture ASL & Signed English Sign Exact English Sign Language from Other Countries Tactile Sign, or Visual-Gestural Communication. Let s define each of these. American Sign Language, or ASL, is the sign language native to the United States and has a unique grammar and vocabulary. Sign Exact English is a language which uses signs of exact English and grammar. Mixture ASL and Signed English is a mixture of these two types of formalized sign language. Sign Language from Other Countries refers to sign language that is native to another country. Tactile Sign is used by people who are deaf-blind and use sign language to communicate. The person who is deaf-blind places their hands on the signer s hands to feel the shape, movement, and location of the sign. Visual-Gestural Communication is not a language like English, or American Sign Language. It is a communication mode that uses gestures, facial expressions, and body language. Often individuals, who cannot communicate effectively using either a spoken language like English or a formal signed language like ASL, will be able to communicate more effectively using natural gestures. It is possible that an individual may use a combination of two of these modes of communication. For example, an individual may use some words and some signs to communicate, a mixture of Verbal and ASL. You should select the individual s primary mode of communication in this situation. Once a communication assessment has been completed for the individual, the recommendations from the assessment will drive which mode of communication is chosen.

48 An individual who is Eligible for Enhanced Communication Services must have a completed Deaf Services Assessment and be found to be In Need of Enhanced Communication Services. Once the standardized communication assessment is completed for an individual, this assessment should be documented in the Other Non-Medical Evaluation screen of the ISP. Remember that the standardized communication assessment will be completed for all individuals who are deaf and in the Consolidated Waiver or in intent to enroll in the Consolidated Waiver.

49

50 At this point in the presentation, we d like to introduce you to Maureen Veety, the Deaf Services Coordinator, or DSC, for ODP. As part of the Harry M. settlement agreement, ODP hired Maureen to provide a specific set of roles and responsibilities related to supporting people who are deaf and the SCs, providers, and others who support them. Maureen has been in this role since February 3, Next, you will see Maureen introducing herself, giving her name and her title as Deaf Services Coordinator, using American Sign Language. If you d like to read along while Maureen signs, the English translation will be in the notes pane on the right side of your screen.

51 (video playing; no audio) Hi. My name is Maureen Veety and it s signed like this. I m the new Deaf Services Coordinator for the Pennsylvania ODP.

52 Before becoming the Deaf Services Coordinator, Maureen worked for both the Bureau of Human Services Licensing and ODP as the licensing administrator for the Northeast Region. Before her time with DPW, she worked as a social worker at the Scranton School for the Deaf for 20 years. 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 ID system. We ll talk more about the Deaf Services Coordinator s role and responsibilities in the second webcast in this series, but wanted to share some basic information with you about when and how to contact Maureen.

53 Supports Coordination Organizations should contact the ODP Deaf Services Coordinator if any of the following occur. The SC has difficulty finding a provider to meet a communication need identified in the ISP. The SC becomes aware that a communication assistance need is not being met as specified in the ISP. The SC needs support in arranging an interpreter, after using resources at a local level.

54 Supports Coordinators may also need to contact the DSC to arrange or schedule communication assessments. As of April 2014, these assessments are still in the pilot stage, but SCs will be receiving more information from the DSC and ODP about these assessments in the future. If a class member is in need of enhanced communication services prior to the implementation of the standardized communication assessment, the individual s Supports Coordinator should contact the DSC. If a Supports Coordinator is looking for information on provider vacancies or providers who have expertise in supporting individuals who are deaf, the DSC is a good resource. The DSC can also provide information about SCs in PA who have specialized experience in working with individuals who are deaf and about assistive technology resources.

55 Here is the contact information for Maureen. Please note, Maureen is hard of hearing and, therefore, has difficulty hearing voic messages clearly. It is best to contact Maureen by if possible. If you call her and are not able to get in touch with her directly by phone, please send her an with a short description of your concern and your contact information so that she can make sure to get back to you.

56 (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)

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