Language Access Resolution Agreement

Unites States Department of Health and Human Services Office for Civil Rights Peter Chan, Regional Manager JFK Federal Building, Room 1875 Boston, MA 02203 Re: Maine Department of Health and Human Services Reference Number 01-97-3096/97-06787 Dear Mr. Chan: In accordance with the terms of the above referenced Resolution Agreement section IV.S Specific Provisions: Monitoring, I certify that the Maine Department of Health and Human Services has: 1. Reviewed a sampling of LEP individuals‟ case records and complaints; 2. Sampled staff‟s and contractors‟ knowledge about language assistance; 3. Reviewed lists of bilingual staff, interpreters and other resources; 4. Requested feedback from LEP individuals and advocates; 5. Reviewed distribution of translated documents and signs in public assistance offices; 6. Assisted with recruitment of bilingual staff; 7. Analyzed the impact of all procedural and policy changes affecting LEP; 8. Reassessed the linguistic needs via Assessment (Section IV.C); 9. Developed and conducted a language self-assessment. Attached please find all relevant documentation as evidence of implementation of the terms of the Resolution Agreement. In accordance with your letter dated March 20, 2006, we would request that this matter be closed. We continue to work on language access issues quite diligently, and continue to improve access to services for LEP individuals. The Department‟s contact for purposes of this agreement, as of December 01, 2008, is Noel Bonam. Any questions or concerns regarding the Resolution Agreement or associated compliance with such should be directed to him at (207) 287-4272 or via email at Noel.Bonam@Maine.gov. Sincerely, Brenda M. Harvey, Commissioner Cc: Susan Herman, Assistant Attorney General Language Access Resolution Agreement Status Report from Maine Department of Health and Human Services April 20, 2008 Addressing items in section IV.S - Specific Provisions: Monitoring: To ensure effective language assistance and access to services, ME DHHS shall develop and implement a program to monitor the provision of language assistance services to LEP individuals and compliance with this Agreement. Every two years after the effective date of this agreement (April 20, 2006), the ME DHHS Language Assistance Coordinator shall: 1. Review a sampling of LEP individuals‟ case records to assess whether primary languages are properly recorded in all case records and whether such individuals are provided adequate language assistance services; 2. Review LEP individuals‟ complaints to determine adequacy of language assistance services; 3. Assess a sampling of staff‟s knowledge about ME DHHS‟ language assistance policies and procedures; 4. Assess a sampling of subcontractors‟ knowledge about language assistance requirements and procedures to provide language assistance; 5. Review the accuracy of the list containing the availability of bilingual staff, interpreters and other resources; 6. Request feedback from LEP individuals and advocates; 7. Review the development and distribution of translated ME DHHS-developed documents, and posting of signs in public assistance offices; 8. Assist with the recruitment and assignment of bilingual staff; 9. Analyze the impact of all procedural and policy changes affecting LEP individuals; 10. Reassess the linguistic needs of the affected population by conducting the Assessment for Determining Linguistic Needs described in Section IV.C; 11. Develop and conduct a language self-assessment to determine whether the language assistance services are provided to LEP individuals when they visit ME DHHS offices or contact an office by telephone. The testing program shall include: a. Unannounced site visits to DHHS offices to be conducted periodically; and b. Requests for public and medical assistance information in languages other than English by testers. Information is included on access to services and efforts to address the communication needs of deaf and hard of hearing clients and applicants as part of the overall Language Access initiatives. 1. Review a sampling of LEP individuals’ case records to assess whether primary languages are properly recorded in all case records and whether such individuals are provided adequate language assistance services. Review of random case files in the Offices of Adult Mental Health Services, Adults with Cognitive and Physical Disabilities, Public Health Nursing and the Office of Integrated Access and Support (eligibility for TANF, Food Stamps, WIC, etc.) reveal tremendous progress in the use of interpreters and the proper documentation of that use. There has been definite decrease in the use of family members as interpreters since the Resolution Agreement was signed and mandatory staff training has been implemented. In Public Health Nursing alone, interpreter billing went from $5,000 in 1997 to $60,000 in 2007, an 1100% increase in 10 years. Documentation of primary language is, predictably, not uniform throughout the vast databases and service areas of the Department. For some workers, the use of interpreters is so routine as to be unremarkable. For others, after 25 years of service, they have yet to encounter an LEP client. Public Health Nursing (PHN) serves many LEP clients with large families and complex medical needs. A review of a random sampling of the Portland PHN files reveals improved documentation of Language Access Needs in client files:   PHN client intake database contains fields for race and ethnicity, primary language spoken and language barriers – consistently filled in; TB Control Program preventive treatment referral form has a data element for language spoken. On one form, English was properly noted when the client was sufficiently fluent in English. One instance of perhaps an older version of the form was used, with no language data element; Stickers used liberally: “Needs interpreter services. Language: ____________”; Client record of Interpreter Services and Interpreter Signature of Agreement forms in some files Many visit notes indicated interpreter agency and specific interpreter; Some copies of authorization and consent forms in the needed language in file; if not in the language, then the interpreter signed off as having interpreted the form.     Overall observations: DHHS staff is more aware of language access issues and the obligation to provide accommodations than they were two years ago. Databases are still in the process of revision and language demographic data are being entered. Case files are beginning to reflect this new awareness. Mental Health client intake forms have been updated to include language data fields. A request has been made for staff to be instructed to record language demographics, even in “shell” files. Feedback and recommendations based on the file review have been sent to management. Ongoing education is needed to continue forward progress. Trainings continue to be offered on line, and in person. Specialized training and hands-on practice is arranged for work groups and for groups that are geographically co-located. 2. Review LEP individuals’ complaints to determine adequacy of language assistance services The Language Assistance Coordinator received four complaints during this initial two-year reporting period. Two complaints were regarding the quality of services delivered by Language Line Inc., and were addressed with the provider immediately. Language Line responded by apologizing to both the DHHS worker involved and the LEP client (as well as refunding the cost of the call). One complaint was brought forward on June 2, 2006 by an advocate from Maine Center on Deafness involving a family with a Deaf parent and DHHS Child Protective staff. A thorough description of the DHHS staff‟s appointments with the parent, and an outline of the events of the interaction without an interpreter was provided by the case worker to the Language Assistance Coordinator on June 13 in a memo. The caseworker cited her familiarity with DHHS‟s Language Access Policy, her previous experience in serving this family and the provision of qualified (in this particular case, a nationally-certified, state-licensed and “legally- qualified”*) sign language interpreter. The memo showed the caseworker complied with policy directives and acted in good faith, following the best practices recommended in the Language Access Training. The final complaint also involved a failure to provide sign language interpreters. A settlement was reached with the complainant and the staff involved received additional training. Review of these complaints indicate that DHHS‟s Language Access policy, training and resources are adequate to substantially meet the requirements of the Language Access Resolution Agreement. * A list of “legally qualified sign language interpreters” as maintained by the Maine Division of Deafness can be found at: http://www.maine.gov/rehab/dod/legal_interp_info.htm 3. Assess a sampling of staff’s knowledge about ME DHHS’ language assistance policies and procedures: In general, DHHS staff knows the basics of requesting interpreters and setting up appointments. There is still a learning curve around utilizing the telephonic interpreting companies to help identify the individual‟s language. Those staff who serve LEP clients on a regular basis are predictably more competent in the use of interpreters and have interview rooms or home visits structured so that language assistance can easily be provided. Respondents worked in a wide range of DHHS program areas: Public Health Nursing, Office of Elder Services, Division of Support Enforcement and Recovery, Office of Child and Family Services, Regional Operations, and Office of Integrated Access and Support. Services sampled covered the length and breadth of the state. In response to the survey, those with erroneous answers were provided with the correct information and offered the opportunity to take the on-line Language Access Training, even if they had attended in-person training. Below is a summary of the staff surveys in the Rockland Office, as reported by the Local Language Access Coordinator: ‘Some had very good knowledge levels while others not as good but ok. They all knew where to seek assistance if they needed such as seeking help from office manager, that being myself. They all knew we had a system in place. ‘Some had used this system and had been very successful. Most thought we had only 1 contract telephone interpreter company such as the one that is in our speed dial system being *960. I train new people when they first come in and I train them with that number, therefore I need to take the blame for this. I have given staff in the office today a sheet with both numbers, the number for the Language Line, 1-800-874-9426 which is the speed dial and the number to Pacific Interpreters 1-800-870-1069. They are aware that policies can be found on the web ‘They know that we need to have access to translate documents as lots of pamphlets are already in different languages. They knew that children could not be used as interpreters but some thought that family members could be used as interpreters. All had the in-person interpreter training but not the on-line version. I have forwarded to staff who were interested the on-line version that was sent by Kate Carnes back in November/07 so that they could take this training if they so wish. I have asked our receptionist to do the on-line version as she is the first point of contact and she did go through that version this afternoon.’ 4. Assess a sampling of subcontractors’ knowledge about language assistance requirements and procedures to provide language assistance: The staff of the Maine Office of Multicultural Affairs interacts with subcontract agencies on a regular basis and assesses the levels of knowledge related to LEP clients on an ongoing basis. The Language Access Coordinator is called frequently with questions about interpretation – when it‟s needed, where to find interpreters, how to pay for them - and bilingual staff. In addition, agency-specific Language Access Training, modeled after the DHHS Language Access Training, has been provided to more than 33 subcontractor agencies/forums for agency education and training, reaching more than 1,000 health and social service subcontractors. A list of the agencies and indication of the number of attendees can be found in the Attachments Section of the report. Training was also provided to future contractors, in social work, nursing and public safety classes at Southern Maine Community College, University of Southern Maine, University of New England, and Unity College. Complaints and concerns expressed to the Language Access Coordinator are promptly addressed and include an offer of training for agency staff on language access issues and accommodations. For example, concerns regarding Regional Transportation Program (RTP) in Portland prompted several meetings and culminated in a training session for RTP dispatch staff. When a complaint was called in subsequent to that initial training, discussion with RTP administrators revealed a lack of training in language identification on the part of RTP staff, which they have agreed to correct. Additional test calls will be made periodically. A summary of the resolution emails can be found in the attachments and supplemental information. The state‟s Refugee Coordinator has observed subcontractors in Portland and Lewiston, especially those serving newly-arrived refugees and elders who arrived in refugee status. The program is run by Catholic Charities Maine, which also runs Maine‟s largest spoken language interpreter referral service. The coordinator has observed interpreters being utilized appropriately for the monthly Cultural Orientations for both secondary migrants and newly arrived refugees who are Somali, Somali Bantus, and Swahili speaking Somalis. Catholic Charities Maine‟s Elder Services Grant also employs a Somali speaker, an Ethiopian Amharic and Tigrinya speaker, and an Ivorian man who speaks (West African) French, to better serve the Togolese in Lewiston. Coastal Enterprises Inc. (CEI ) is implementing DHHS‟s Refugee Individual Development Account grant. CEI has been using United Somali Women (an interpreter referral service) and a Sudanese man who speaks Arabic in addition to other Sudanese languages in order to communicate with the program participants. Elder Independence of Maine has instituted a system of providing translated materials and notification of assistance in understanding printed material, and tracks all correspondence with LEP clients. 5. Review the accuracy of the list containing the availability of bilingual staff, interpreters and other resources DHHS staff in the in-house language bank has been reviewed and updated as of September 18, 2007. Additions are made when new bilingual employees are hired. A major update is underway as well. A portion of the most recent list is included in the Attachment Section of this report. Efforts are being made so that the state human resources database can generate lists of bilingual staff statewide, eliminating the need for hand-tabulation and updating, while highlighting the importance of tracking language capacity throughout all of state government. There is a reluctance to put forward the names of interpreters and interpreter referral agencies when it is impossible to know the credentials for the provider and the quality of the services. One major barrier in the provision of qualified interpreters is the lack of standardized requirements to be a spoken language interpreter (This is not the case for sign language interpreting). This is a nationwide issue. Much time has been dedicated by this office to train interpreters and to create an infrastructure that will support sustained education efforts, as well as to educate providers of ALL services about the need for and the value of trained interpreters. Until interpreters can earn a living as an interpreter, there is little incentive to acquire the requisite training and continue to seek employment in the field. The Language Assistance Coordinator works closely with the Language Access for New Americans (www.lanamaine.org), the Maine Judicial Branch, the University of Southern Maine‟s Department of Linguistics (www.usm.maine.edu/lin/Program/ASL%20Program.html) and other stakeholders to deliver basic and advanced medical interpreter training to interpreters. A list of community interpreters is maintained in the DHHS Language Access Policy on line, which was last updated in February 2008. Additional interpreter referral agencies are being added in May. This listing, as attachment #8 to the policy, is available to DHHS workers and the general public on line at http://www.maine.gov/dhhs/policies/. In addition, the Maine Multicultural Resource Guide has a section devoted to interpreting (http://www.maine.gov/dhhs/oma/MulticulturalResource/interpreting.html). This document is updated regularly as new information comes in. 6. Request feedback from LEP individuals and advocates The Language Assistance Coordinator is in frequent contact with community members and LEP advocates at many community functions and meetings. Feedback on DHHS Language Access initiatives is discussed at many of these venues. The Coordinator is well-known by the interpreting community, both signed and spoken languages, and encourages all barriers to communication, whether to DHHS‟s or to a contractor‟s service, to be reported. In addition, the staffs of the Maine Office of Multicultural Affairs and the Maine Office of Minority Health solicit feedback on DHHS performance on Language Access issues and cultural competency. No matter the size of the group, one-to-one or a large statewide forum, Language Access is on the checklist for topics to be covered. A sampling of large community venues and forums include: Festival of Nations (2 years) World Refugee Day (2 years) Deaf Culture Festival (annual) Annual DHHS Deaf Services Conference (annual) Partnership for a Tobacco Free Maine Community Forum Refugee and Immigrant Mental Health Collaboratives (monthly meetings in Portland and Lewiston) NAACP Wellness Day (2 years) Department of Labor‟s Pre- and Post-Harvest Forums Migrant and Seasonal Farm Workers Health Council (quarterly) Cesar Chavez Award Ceremony (2 years) Association of Late Deafened Adults Maine Immigrant Rights Council 211 Multicultural Committee Minority Health Workforce Development Round Tables (Portland, Augusta, Bangor, Caribou, Machias, Fort Kent) The Language Access Coordinator has joined the DHHS Access Work Group, which is leading the Department‟s efforts to improve access to DHHS services in the broadest sense – addressing issues that range from where office buildings are physically located to the usability of the web site. This work is especially vital as the Department continues to merge two of Maine‟s largest state agencies into one well-coordinated work unit. This group has proven to be an excellent venue to address the systemic issues of language access across program/service and geographic areas. On March 21, 2008, the Access work group invited four key advocates to address the group and encouraged them to bring LEP individuals, specifically to provide feedback on language access issues and to make suggestions for improved relations with the LEP communities. Advocates included: Amy Sneirson, Esq., Civil Rights Program Director, Maine Center on Deafness Malvina Gregory, Program Manager, RISinterpret, Catholic Charities Maine Refugee and Immigrant Services, and a Spanish/English Interpreter Dr. Osman Hersi, President of Maine State Interpreters Daud Mohamed, representing the Somali Community Anais Tomezsko, Director, Mano En Mano, a community service organization located in Washington County serving a pocket of Spanish speakers. Questions posed included: What barriers do LEP clients face when attempting to interact with DHHS? Do individuals feel they have to come in person rather than calling due to the language barrier? Are there significant delays in receiving services due to the language barrier? Responses varied with population group and locale.  The Spanish speakers in Washington County did not report substantial concerns regarding access to DHHS services, though the advocate has heard of people coming in to the office rather than calling, or asking the advocate to place the call for them.  The Somali community reported great difficulty in understanding concepts about DHHS services, and report that initial cultural orientation upon arrival in the United States is insufficient for unique needs that arise and necessitate interaction with DHHS. Requests for language specific community forums to discuss topics such as Preventive Health, Divorce, Child Protective and acceptable disciplinary techniques, and MaineCare have been proposed. The Maine Office of Multicultural Affairs and the Office of Minority Health will work with program area “content experts” and community leaders to set up future community forums.  One specific barrier mentioned is the “take a number” system of service in the Portland office, given that some clients cannot read their number and do not recognize the number when called out in English. Alternatives and low tech solutions to this barrier are being discussed.  Deaf consumers‟ concerns about a lack of walk-in service due to interpreting needs brought a discussion of the use of DHHS‟s existing videoconference equipment in most office locations as a means of providing qualified sign language interpreters into areas of the state where none are readily available.* In depth minutes of this meeting are included in the Attachments. *Sign language interpreters in Maine are a licensed pool of practitioners. Licensure data show no interpreters reside or practice in large areas of rural Maine – Aroostook, Washington or Hancock counties; few in Piscataquis and Lincoln counties; and only in the southern, more urban part of Penobscot county. The Language Assistance Coordinator is a member of the Licensure Advisory Council which sets the standards for licensure, and is a Local Test Administrator for the national certification testing of the Registry of Interpreters for the Deaf. 7. Review the development and distribution of translated ME DHHS-developed documents, and posting of signs in public assistance offices Document Translation: The Director of the Maine Office of Multicultural Affairs is a member of the DHHS Integrated Management Team (IMT) and is in frequent contact with the heads of all major branches and program areas within the Department. His presence on the IMT ensures that each service area remains cognizant of the unique needs of DHHS clientele and program applicants who are members of racial, ethnic and/or linguistic minority groups. While there is no overall document management system for DHHS, an inventory of Vital Documents was completed in 2006, and translation needs were reviewed at that time. Ongoing sampling of printed materials found in each program and office location is conducted by the Language Assistance Coordinator and other staff within the Maine Office of Multicultural Affairs and the Maine Office of Minority Health. Program leaders often call the Language Assistance Coordinator for guidance and direction in translation – in response to requests on the part of clients and applicants and as newly-developed materials are designed, printed and disseminated. Guidelines to assure accuracy, resources for translation and venues for dissemination to reach the target populations have been developed and are shared with requestors. At times, translation of a particular document is not recommended, as there is a substantial pool of LEP clients/applicants who are not literate in their native language or in English. In such cases, the recommendation is to place a phone call through a telephonic interpreter service to explain what would normally have been mailed, to hire an interpreter to sight translate the material, and/or to create a recording of the interpreter in a media that the LEP individual has access to, so they may refer to the content as often as they wish. In the case of material that is not client-specific, this last method also allows DHHS to “capture” the sight translation so that it can be used repeatedly with others similarly situated. Translated materials are gradually being incorporated into the DHHS web site (http://www.maine.gov/dhhs/index.shtml). Additional materials in various languages are stored on the intranet site, available only to DHHS employees in the course of their work. One example of such material available on the web is the Adult Mental Health System‟s Summary of Rights of Recipients documents, available in six languages: Somali, French, Russian, Vietnamese, English and Serbo-Croatian. http://www.maine.gov/dhhs/mh/rights-summary/index.html. Another example is the WIC Approved Foods listing, both on line and included with food instruments distributed to clients, which includes photographs of foods and brands to assist LEP and low literacy moms select the approved foods. http://www.maine.gov/dhhs/wic/nutrition_approvedfoods.htm The overall task of the gradual translation of documents is now incorporated into the work of the CMS Systems Transformation Grant‟s DHHS Access Work Group. A state-wide RFP for translation services has recently been issued. Upon award of the contract, the Language Access Coordinator will work with each unit to assist them in taking responsibility and tracking the translations within each work unit. Signage: Large, colorful signs offering Language Assistance in the 24 languages most frequently encountered in Maine have been posted within each office location, with special emphasis on those offices in which the public is served. In some cases, due to the layout of the facility, multiple copies of these large colorful signs are posted. A sample of the sign is included in the Appendix of this report. In offices equipped with private interview rooms to serve the public, laminated paper versions of the signs have been posted within each room for ease and privacy of language identification. Many office reception desks and interview room desks are additionally equipped with the Point to Your Language brochure supplied by Language Line, offering Language Assistance in 100 languages. In fact, due to the advocacy of this office, Language Line added some languages that are prevalent in Maine and nowhere else, such as Acholi, Nuer and Dinka. Local Language Access Coordinators for each work location are responsible for oversight of signage in compliance with the Resolution Agreement. Office Managers and Regional Directors oversee the work of the Local Language Access Coordinators. A list of the designated Local Access Coordinators can be found in the Attachments Section. 8. Assist with the recruitment and assignment of bilingual staff. In early 2008, a new position of receptionist for the Lewiston Main Street office location was filled by a bilingual Somali/English staff person. This position will assist in greeting and triaging the service needs of the largest non- and limited-English proficient population in the service catchment area, Somali. With the assistance of DHHS Human Resources, now a work unit under the statewide HR structure, this position was upgraded from an Office Assistance II (range 8) to a Customer Representative Assoc II (range 13), listed and posted as “bilingual Somali/English skills strongly preferred.” The Maine Office of Multicultural Affairs assisted in publicizing the newly created position to the Somali refugee and immigrant populations. The incumbent now holding the position has completed training on the DHHS Language Access policy via the on-line training and at New Employee Orientation. The Language Assistance Coordinator will be reviewing the specifics of the Language Access Policy and its application to the Lewiston Office in light of the new language access capability on staff, with an emphasis on further clarification of bilingual staff role vs. interpreter role, along with expectations for mono-lingual English speaking staff. Efforts are underway to recruit a bilingual Chinese/English-speaking Health Inspector for the Restaurant Inspections program. Chinese has been identified as the language most often needed in the Restaurant Inspections program and a position is currently vacant. Since 1995, the Office of Adults with Cognitive and Physical Disabilities (formerly Bureau of Mental Retardation) has recruited and trained staff to be fluent in American Sign Language and other communication modalities used by D/deaf, hard of hearing and hearing/non-verbal clients. Five such staff are identified and are listed in the bilingual employee language bank data. Additionally, the extensive email contact lists maintained by the Maine Office of Multicultural Affairs are utilized to advertise and promote job postings that could be of interest to bilingual candidates, especially those languages needed to communicate with the refugee and immigrant populations. During this reporting period, these announcements included employment opportunities within DHHS, in other state agencies, in city government, University of Maine System, and community-based contractors. The job postings may request bilingual skills specifically, or may be open jobs that do not necessarily advertise bilingual skills, but would provide an excellent opportunity for bilingual persons to enter social service work. We continue to support the on-going efforts to diversify Maine‟s work force. Sample jobs that have been promoted in the past month include:  Somali and/or Arabic speaker at the Department of Labor‟s Career Center in Lewiston  University of Southern Maine  Maine Migrant Health Program 9. Analyze the impact of all procedural and policy changes affecting LEP individuals The Director, Maine Office of Multicultural Affairs, is a member of the DHHS Integrated Management Team (IMT), composed of the DHHS Commissioner, Deputy Commissioners, and upper management. IMT meets weekly and has programmatic and policy oversight for all DHHS operations. The presence of the Director at these discussions and deliberations, assures that Cultural Competence and Language Access issues are heard at the highest levels by DHHS decision-makers, across all Department programs and services. The Language Access and Deaf Services Coordinator has joined the CMS Systems Transformation Grant-funded DHHS Access Work Group. With funding from Centers for Medicaid and Medicare Services (CMS) – Real Choice Systems Change, and in partnership with the Muskie School of Public Service, the Access Work Group is charting the Department‟s course for merging two large legacy Departments into one responsive, accessible service delivery system. Examples of the work that impacts services to LEP clients include: i. IT initiatives that support DHHS business objectives, including data collection for language spoken and accommodations needed, automation of DHHS bilingual Employee Data Bank and posting translated documents on the DHHS internet and intranet pages; ii. Inclusion of the voices and feedback of LEP persons and their advocates in the evaluation of customer satisfaction. The Office of Integrated Access and Support, OIAS, has added core competency expectations to all employees‟ annual performance evaluation. One of these competencies will have a positive impact on the quality of services provided to LEP persons: Interpersonal Relations: Shows respect and tolerance for each person. Relates well to others, possesses good listening skills, and demonstrates trust, sensitivity and mutual respect. Recognizes the contributions diversity brings to job performance and creativity The performance expectations around this competency are included in the Attachments Section. Few formal policies and procedures have been promulgated during the 2-year period covered by this report. Most existing policies and procedures assert the client/applicant retains the right to be free from discrimination with a reference to “Eligibility is determined without regard to race, creed, color, or national origin,” or via a more in-depth recounting of the obligations under the Civil Rights Act and the Americans with Disabilities Act. A sampling of policies and procedures that were promulgated or updated including sensitivity to LEP communication needs is included in the Attachments Section. 10. Reassess the linguistic needs of the affected population by conducting the Assessment for Determining Linguistic Needs described in Section IV.C:  Determine the Language Needs of the Affected Population: a. Non-English languages that are likely to be encountered b. Estimate number of LEP individuals likely to be directly affected by ME DHHS: Census, school system, utilization data from files, state and local governments, community agencies and organizations c. Points of contact within ME DHHS where language assistance is likely to be needed d. Resources needed: bilingual staff, staff interpreters, contracted and/or community interpreters required at each office; translation resources a. Languages frequently encountered in Maine include: Somali Mandarin Spanish Khmer French Arabic Vietnamese Acholi Russian Languages less frequently encountered but pose a challenge to accommodate: Acholi Bari Nuer Vizayan Dinka Korean Sign Language Dari b. According to the 2000 US Census, of Maine‟s 1,204,164 residents, 93,966 or 7.8 percent, speak a language other than English at home (this number remains the same in the 2005 update), and 24,063 or 2 percent, speak English “less than very well” The largest language group is Somali, estimated at 2,200 Somalis in Portland and 3,000 in Lewiston for a total of 5,200 individuals. There is a substantial pool of Somali clients/applicants who are not literate in their native language or in English. For those situations, an interpreter is hired to sight translate documents. Spanish is Maine‟s second most-frequently requested language and population estimates vary as widely as 5,000-9,000 (Maine‟s Federal Advocate Monitor for Migrant and Seasonal Farm Workers) to 12,000 – 15,000 (Immigrant Legal Advocacy Project). The 2000 Census lists Spanish speakers at 9,611, 0.8 percent of Maine‟s population; of this number, those who “Speak English less than very well” was said to be 2,664 people, or 0.2 percent of Maine‟s population. Whatever the estimated year-round Spanish-speaking population might be, that number is estimated to increase by one-third to one-half during the agricultural season, due to migrant and seasonal farm workers. French is spoken as a second language by native-born Mainers in both northern Maine and in the cities of Lewiston and Biddeford-Saco. French is also a second language for some African-born residents. The Department of Education counts 370 students with French as a Heritage Language, or 8.37 percent of the LEP student base. Some estimates place the French-speaking population of Maine at between 5.3 – 6 percent of the population, greater than any other state. The Department of Education reports 239 Passamaquoddy speakers. All other language groups, as estimated by frequency of DHHS encounters using telephonic interpreters (monitored monthly), hospital and court language data, are relatively low incidence. Department of Education heritage language data, migrant farm worker demographics map and Portland Public Schools Language Minority data is included in the Attachment section. c. Points of contact with DHHS when language assistance will be needed include virtually every service area. Some, of a more urgent, emergent, or public health and safety nature, are being targeted for concentrated language access enhancement efforts. A complete list of services available to the public through DHHS can be found on line at http://www.maine.gov/dhhs/prov_divisions.shtml . d. Resources needed include:  bilingual staff reflective of the languages most frequently encountered, including American Sign Language  trained local, in-person interpreters and translators  telephonic interpreter contracts (two in place, with translation capabilities)  Funding for each work unit to hire interpreters and translate documents (vital documents in advance and others on demand ) All of these resources are in place and available to some extent, all are a work in progress, with concerted efforts to address these needs. 2. Determine the Language Needs of Each LEP Individual a. In-person communication: I speak cards, poster-size language list, telephone service b. Telephone communication: use of telephonic interpreter service c. Documentation: in individual’s file a. As noted in #7, posters offering interpreter services in 24 most frequently-encountered languages in Maine are posted in every office location and in many interview rooms, along with the Language Line identification brochures (500 have been distributed within DHHS and are downloadable from the DHHS web site language access page.) b. Telephonic interpretation is encouraged and forms the backbone of our Language Access plan due to the emergent nature of many DHHS services and unpredictable needs of our clients. Interpreting usage (and costs) has increased dramatically during this reporting period due to enhanced staff awareness of our obligation to provide language access. Contracts are maintained with both Language Line and Pacific Interpreters. c. As noted in # 1, data systems are in process of adding language fields, case files are increasingly marked with language and communication barriers. 11. Develop and conduct a language self-assessment to determine whether the language assistance services are provided to LEP individuals when they visit ME DHHS offices or contact and office by telephone. The testing program shall include: a. Unannounced site visits to DHHS offices to be conducted periodically; and b. Requests for public and medical assistance information in languages other than English by testers. a. Unannounced visits to Lewiston, Portland, Augusta, Rockland, and South Paris have been conducted. Augusta, Rockland and South Paris had no LEP persons in evidence during the visit. In the Fort Kent and Caribou offices, where French is the most frequently encountered language, many staff are bilingual and can assist clients directly in French. Somali is the predominant language DHHS needs to accommodate for in the Portland and Lewiston offices. Observations revealed that interpreters have been routinely provided for new recipients of service for the lengthy orientation program. The interpreters utilized in Lewiston are mostly from United Somali Women, a well-established referral service with a longstanding relationship with DHHS. The Somali-speaking receptionist has been observed serving both English and Somali speaking customers effectively and politely. There are scheduled “Somali Tuesdays” in the Portland Office, when a trained interpreter hired through Maine‟s largest spoken language interpreter referral service, RISinterpret, run by Catholic Charities Maine, is present in the office for six hours. This interpreter has become familiar with DHHS terminology and procedures and assists with walk-ins and pre-scheduled appointments. When Somali speakers arrive with no prior notice on other days, they are assisted with telephonic interpreting services. b. Requests for information in other languages is another area where staff ability to respond appropriately is impacted by the frequency of the interaction with LEP members of the public. Some areas, such as the Adult Abuse and Neglect hotline, rarely receive calls in other languages. Staff were caught off-guard by the test call, despite having been asked about Language Access training and receiving a folder of information about two weeks prior to the call. The Child Abuse and Neglect hotline has an automatic recording in English, asking those who are making or calling about a report of abuse or neglect to first dial 1. Once connected to a live person, she had the information on language access at her fingertips in a binder. The telephonic interpreter companies‟ phone numbers were not pre-programmed into the phones as was recommended in the Language Access Training. Follow up with supervisors and staff has rectified this situation. The Maine Tobacco HelpLine has five bilingual English-Spanish intake employees and bilingual English-Spanish coaches to work with enrolled participants. There is a contract with telephonic interpreters, and staff knows the protocol and billing code. Printed materials are available in English and Spanish. Data fields list additional languages for tracking purposes, allowing staff to instantly access interpreters for incoming and outgoing calls to participants. Program staff has been trained to use the telephone relay services for deaf and hard of hearing callers as well. Attachments and Supporting Data 1. Review a sampling of LEP individuals’ case records OIAS (Office of Integrated Access and Support) cases reviewed included: 1. Language: Zande Service: OIAS – 6 month food stamp review. Computer records sporadically indicate name of interpreter used to communicate with client re: car repairs. Not always clearly interpreter role. At times Language Line did not have a Zande interpreter available. File notes Arabic “foreign language insert” in mailed communications. Recommendations: a. Cultural brokers such as the role this interpreter has taken on can be listed in computerized case file as “aider” permitted to communicate client‟s information, with a release of information on file. b. “Notes” view in electronic files can be utilized for alerts such as auxiliary language access information, such as interpreting agencies that offer the needed language, and additional languages (i.e., if primary language (Zande) is not available, is there is another language (Arabic) that can be utilized). 2. Language: Somali. Family – man, wife, child, all recently arrived refugees, no English skills Services: all OIAS-related services Initial encounter case notes record the Refugee Resettlement case manager and „translator‟ present; both parents read Somali. Primary OIAS worker on this case serves all recently arrived refugees and doesn‟t routinely document use of interpreters as it is standard practice. When a “floor worker” (whoever is on duty at the time to service walk-ins) makes case notes, the use of interpreters is noted in the file. An incoming call from the client is documented, with interpreter information included. Recommendations: a. Community referral sheets (information about community-based, non-DHHS services) given to clients could be translated. Portland office OIAS supervisor will give a copy of the information book to the Language Access Coordinator to review for translation. b. Language Access Coordinator will send the Portland office OIAS supervisor the internal DHHS interpreter billing codes for the interview room reference books and post-its. c. Tuesday is „Somali Day‟ with a regularly scheduled interpreter, trained in DHHS services and protocols, standing by. If the encounter occurs on a Tuesday with the assistance of the Somali interpreter it still needs to be documented or noted. 3. Language Vietnamese, family of 5 Services: all OIAS Both paper and electronic files note “foreign language inserts” for mailings. Paper files note use of Pacific Interpreters, more in the early services (2006) and less frequently recently. It is possible that the family began acquiring more English skills. 4. Language: Farsi, widow and four children, here since 2004. File notes Non-English speaking Services: all OIAS Note from 2004 indicates client brought sister-in-law in to DHS office to interpret. Letters were mailed in Farsi/Afghanistan 7/2004 note shows “an interpreter called” to discuss an issue – not a professional neutral interpreter. 9/2004 phone call notes “sister translated” 9/05 notes daughter called DHS office 12/06 notes use of Language Line interpreter for Dahri (Dari is a dialect of Afghani Farsi) 3/07 notes use of Language Line interpreter for Dahri, and permission is given for DHS to speak to the client‟s brother to assist the client. However, this is poorly documented, with no information about the brother, and not listed in the “assist” section. 7/07 Scheduled client for a TANF Limited Language training with Farsi. 12/10/2007 Extensive appointment @ 3:30 with no note of use of interpreter for that appointment. Cross reference with Language Line bill shows Dari interpreter utilized for 58 minutes. Note: Clear improvement in use and documentation of interpreter services 2004 – 2008 Recommendation: Research if computer program ACES can be programmed to correlate field for English ability NO with a pop-up box regarding interpreter usage? Public Health Nursing cases reviewed included: 1: Somali, family of 4, arrived in US 8/07, entered Maine services as secondary migrant 2/6/08 Travel folder sticker on cover: Needs interpreter services Language: Somali Client Intake Data Base info: yes for one family member; lists Spanish for Mother. Persons present at meeting includes interpreter Brother: Service agreements: Consent, Authorization forms in Somali, with signature lines for interpreters. Interpreter Signature of Agreement in file 2/8/08 PHN Client Assessment: Attends ESL Level 4, Cultural Barrier Visit reports: 5/21 notes reference to communication log and use of speaker phone 4/25 checks for comprehension of next appointment date 3/7 visit note: case manager, Abdirahman, interpreted this visit 3/4 MSI interpreter, Osman Hersi, interpreted this visit at MMC TB clinic 2/15 MSI Somali interpreter, Basra Isse, interpreted this visit 2/15 notes using a Somali interpreter from the Family Shelter 2/6 MSI interpreter request form for 2/8 2/8 client record of interpreter services, accepted interpreter. Name and agency of terp noted Mother: client intake form notes Spanish Client record of interpreting services, accept, names interpreter & agency, interpreter signature of agreement Somali Consent form Client care plan notes language, cultural and educational barriers; unfamiliar with options/procedures for obtaining services, provision of interpreter services and advocacy needed by PHN. 5/5 oldest brother declined PHN to call interpreter, as he promised to tell mother 4/25 notes PHN requested oldest brother to interpret for 10 minute visit report. Depends on brother as he is only English speaking in family. Brother has cell phone, no land line. 4/8 home visit notes Brother who requested interpreting when scheduling home visit was not home as he is actively job seeking LLS# 1141 used with PHN speaker phone as only cell is with Brother. 3/25 relies on brother who speaks English…requesting PHN use brother to interpret 3/7 notes Abdirahman, Family Shelter case worker, interpreted 10 minute visit, covers understanding, demonstration of taking meds, notes entering appointments on family calendar 3/4 MSI interpreter, Osman Hersi, interpreted this visit 2/26 no interpreter noted 2/14 family shelter Somali interpreter interpreted this visit 2/8 Somali interpreter, Basra Isse, interpreted this visit Daughter: Primary spoken language: Somali. Communication barrier: Deaf/mute 5/21 notes home visit with Uncle and mother, with rare interpretation to mother. Daughter welcoming, using several appropriate gestures 5/1 Uncle calls to ask location of daughter‟s appointment 4/25 notes going through uncle to give reminder to mother 2/8 Somali interpreter, Basra Isse, interpreted this visit 2: Somali family of 10 File folder marked with Needs Interpreter Services, Language Somali stickers, top and spine. Intake assessment notes presence of unidentified interpreter MM, brother, 20 yo: Client intake – speaks a little English, interpreter at intake Service Agreement/Consent for Services in English, interpreter signature provided Authorization in English 8/11/06 Client Assessment notes language barrier, no note of interpreter Client Care plan notes PHN will provide interpreter for home visits 2/17/07 Scheduled MSI interpreter, BI, present. 11/15/07 Scheduled MSI interpreter, BI, present 10/19/07 Scheduled MSI interpreter, BI, present 8/3/07 no interpreter note 7/5/07 CCME-RIS interpreter, BI present 5/31/07 CCME-RIS interpreter, BI present 4/24/07 CCME-RIS interpreter, BI present 3/23/07 CCME-RIS interpreter, BI present 7/14/06 CCME-RIS interpreter, NH present 6/23/06 CCME-RIS interpreter, NH present 6/22/06 CCME-RIS interpreter, NH present 6/8/06 CCME-RIS interpreter, NH present 5/5/06 CCME-RIS interpreter, NH present 5/2/06 CCME-RIS interpreter, NH present Copies of 10 MSI interpreting request forms 5/31/07 - 3/26/08 5/2/07 Consent for Tuberculin Skin test, home setting, in English, interpreter signed. Note: copius use of professional interpreters with adequate documentation. 3. HA, 42, Somali, speaks no English 10/13/06 Intake Data base shows interpreter present 5/2/06 Client Assessment notes Language Barrier, unable to communicate concerns to provider, unfamiliar with options/procedures for obtaining service, no note of interpreter Service Agreement/Consent for Services in English, signed by interpreter 8/3/06Client Care Plan notes PHN coordination of interpreter for home visits, advocacy with other providers Note: Immediate improvement in documentation shortly after Resolution Agreement signed. 4: 37 year old woman 2/25/08 Client intake data base notes race and ethnicity. Primary language: English. Language Barriers: native language is Portuguese Email from client in file demonstrates sufficient English and attendance at nursing school Note: Proper documentation of English abilities 5: Female, 32. Primary language: Zande, speaks English. Race listed at both Black/African American AND American Indian or Alaskan Native. Born Sudan, so American Indian is unlikely to be accurate. ACES case summary print out does not show Language, file folder is marked “Needs interpreter services” but language is blank TB Control Program Preventive Treatment Referral: Language spoken = English 6. Somali male, 42 File binder marked with interpreter need 3/20/08 Client intake Data Base: race, ethnicity, Language Spoken: Somali Language Barriers: needs translator Consent & authorization forms in Somali, no interpreter signature Client assessment and Initial Visit forms note language barrier Client care plan does not note need for interpreter, only “monitor client‟s ability to communicate needs satisfactorily” (has additional barriers of mental illness) and advocate with other providers. Note of Somali written information given 4/28 visit report notes discussion with guardian, informed if questions call PHN and telephone interpreter will be obtained. Notes cultural barriers of traditional views of mental illness perceived as devil possession and treatment consists of reading Koran, visiting mosque; staff encouraged medication and reading Koran. Note of MSI translator present, under Coping Skills. Client records of interpreter services in file, MSI request form copies Older Maine TB form does not list language spoken, only country of origin Note: Well done, especially in light of additional handicapping condition. Adult Mental Health Intensive Case Management: 1. Paper file. Client clearly speaks another language; the name of the language was not documented. In one instance the notes reflected using the client‟s brother as interpreter. Staff reported verbally to me that the referral source had informed her that the language needed was not always available through Language Line. Staff did not know that DHHS has a contract with another telephonic interpreting company, Pacific Interpreters, who could also be called, or that one could set up an appointment in advance for a specific language needed through the telephone interpreting agencies. 2. Computer file. 42 year old Spanish speaking male Data in language drop down menu not indicated. Only name, age and date were recorded, as the only function provided by this office was a referral to community-based services. 3. Computer file. 34 year old Somali male Data in language drop down menu not indicated. Only name, age and date, as the only function provided by this office was a referral to community-based services. More files, same scenario. Recommendation: As the work of the Intensive Case Managers evolves to a referral source only where minimal data is captured, race, ethnicity and language spoken must be added to the short list of captured data. EIS “Face Sheets” (the opening computer screen for client data) should indicate language spoken and any communication barrier alerts. 2. Review LEP individual’s complaints (email, read from the bottom up) From: VanHorn, Beverly Sent: Thursday, April 10, 2008 8:31 AM To: Curtis, Norman Cc: Tosswill, Julie; McCormick, Brenda Subject: RE: Concerns about MaineCare and RTP Norman: Hope this helps. The Administrator of RTP is John McNulty. I talked with “MY” contact person and was told that they have all been trained to use “Language Line”, an interpreter assists with the call. The agency also bills MaineCare for the service. The agency stated they did get a call and could not determine what the language was. They felt like it was a “prank” call, as Cindy was asked by her co-worker to help the caller and when she got to the phone the person hung up. RTP informed me that they will contact the language line folks today and see how to deal with a call that they can’t figure what the language is. Bev From: Curtis, Norman Sent: Thursday, April 10, 2008 8:07 AM To: VanHorn, Beverly Cc: Tosswill, Julie; McCormick, Brenda Subject: FW: Concerns about MaineCare and RTP Hhmmmm…know anything on this? Norman Curtis Director, Member and Provider Services Office of MaineCare Services Tel. (207) 287-5336, Fax (207) 287-8682 Caring..Responsive..Well-Managed..We Are DHHS. From: Troop, Meryl Sent: Wednesday, April 09, 2008 12:53 PM To: Curtis, Norman Subject: Concerns about MaineCare and RTP Lisa Sockabasin (Office of Minority Health) suggested I start with you and see who is the right person to speak to – A community member recently complained to me about Regional Transportation Program, a contractor funded by MaineCare in Portland, not providing the required language access accommodations for limited English Proficient persons to communicate meaningfully with them. A co-worker and I recently made a test phone call in French and confirmed the lack of accommodation. Who is the contract administrator for RTP? Would that be the right place to start? Thank you for your help, Noël Bonam B.Sc., M.P.M. Director of Office of Multicultural Affairs State of Maine 221 State Street, 11 State House Station Augusta, ME 04333 Phone: (207)287-4272 Fax: (207)287-4052 TTY: 800-606-0215 Email: Noel.Bonam@maine.gov 3. Assess a sampling of staff’s knowledge about ME DHHS’ language assistance policies and procedures: Questions and a summary of answers: 1. If a limited English proficient (LEP) person called, would you know how to get an interpreter on the line? 15 Yeses, Use the conf. hold feature. Dial 1-100-870-1069. Customer service associate will prompt with information. Will be place on hold and connected to the interpreter in less than 30 seconds. Yes ask the caller to hold while you connect with the DHHS Interpreter Lang. Line @ 1-800-8749426 (OIAS billing code 10A4142) for a 3-way conference call Yes, I have filed my paperwork given out at the training (Language Access Policy and Access Captioning Technology). The number I would call for Pacific Interpreters Procedures is 1-800-870-1069 and enter my client ID XXXX and follow the steps in the guidelines. To Language Line Procedures call 1-800-874-9426 for operator access and 1800-367-9559 for automated access No 2. How many telephone interpreter companies does DHHS have contracts with, in case the first one you try doesn’t have the language you need? 2 - Do not know; 9 -I THINK THERE IS TWO; PACIFIC AND LANGUAGE LINE, however I only have the information on how to use one (I only have the office code to use for Pacific Interpreters). I see there are many companies that can be called but do not know how many DHHS contracts with. [Reporter’s note: this is correct, there are 2 companies] 2 - I’m not sure if they have more than one main company that contracts out to multiple interpreters as needed Several 3. Where can you find information about language access policy and procedure? 2 Have on my desk 5 - Policies and Procedures on web WE WERE ALL GIVEN INFORMATION ON IT – IF YOU DON’T HAVE YOUR COPY, YOU COULD LOOK IN OUR “S” (shared) DRIVE IN THE SUB-FOLDER “CLERICAL”, LOOK IN THE RESOURCE BOOK (LOCATED IN THE INTERVIEW ROOMS AND IN THE OFFICE), ASK YOUR SUPERVISOR OR ASK THE OFFICE MANAGER. 2 - Lobby of our office. Maine state website under Deaf Services. At my desk or on the common drive; Contact Meryl Troop or Luc Nya, but haven’t their jobs been eliminated? Also a link on the state web page. Under my Favorites or Maine.gov – Maine DHHS policies, click on Language Access Policy. We also have a hard copy in a blue binder labeled Language Access Policy. We have placed the information on each computer monitor, in everyone’s rolodex, and there is also a one-page informational sheet for reference In the Language Access Policy that I received at the training Meryl Troop had in our office. Meryl Troop 4. Do we have to translate documents we send to LEP clients? 6- No, just offer an interpreter; If their language is known it is indicated in our computer system and a cover letter is sent with all decisions advising the client if they need interpreter services to contact our office. 6 - YES if no written translation is available then in-person or translation via phone will be provided; Yes with the help of an interpreter (?) By using CART, it is able to translate all information into appropriate language for the individual. I do not know 5. Can family members or children be used as interpreters? 14 No’s No it is DHHS general policy to use the language line to be sure that what client states, and what the employee is saying to the client is interpreted, without bias. No, they may not be impartial during the meeting. They may not translate properly for whatever reason. 6. Did you take the in-person interpreter training or the on-line version? 13 In-person I TOOK THE IN-PERSON INTERPRETER TRAINING (WHICH WAS PROBABLY 1½ - 2 YEARS AGO). In person, with Meryl Troop training was taken. In person interpreter training with Meryl Troop. In-person training, Meryl was great. Neither  I can not answer any I hate to say. If I was to get a call I would call the front desk and ask for assistance. I took the course in person. DHHS LANGUAGE ACCESS TRAINING: Total DHHS staff trained as of April 30, 2008: 3, 486 out of 3,800 employees In person 2-hour training: 2,961 On line training: 535, of these 108 also attended the language access module at New Employee Orientation. Note all new employees are included in this count; they can not come into New Employee Orientation until they have taken the on-line training. The total from December to April 30, 2008 is 323. For that same time period we had 108 employees complete New Employee Orientation, where they had a presentation as well as having completed the on-line training. As of December 4, 2007: the number of DHHS employees who have taken Language Access Training. From February 28, 2005 to November 9, 2007 = 2,961 employees took the in-person training. In November 2007 an additional 202 have taken the on-line training. That is a total of 3,163. Starting in January for Orientation all employees coming to that program will have to take the on-line training before attending. 4. Assess a sampling of subcontractor’s knowledge about language assistance requirements and procedures to provide language assistance Based on inquiries and requests from subcontract agencies and assessment of their need for training, two-hour Language Access Trainings were provided to (partial list, not inclusive): Goold (Elder services) provider group (50+ attendees from 10 contract agencies) YMCA of Greater Portland – 8 attendees Alpha One – 15 attendees York County Community Action – 8 attendees TriCounty Mental Health/Trauma Informed System of Care Senior Spectrum Assistance Plus Lewiston Refugee Mental Health Collaborative – representatives from 12 agencies Frannie Peabody Center New England Rural Health Round Table – representatives from 7 agencies WIC Providers conference, 84 providers Motivational Services, Inc. Central Maine Medical Center St. Mary‟s Hospital – administrators and Grand Rounds Maine Coalition to End Domestic Violence, 12 member agencies American Cancer Society, Maine Chapter Acadia Hospital (psychiatric) Dorothea Dix Psychiatric Center Grand Rounds – 8 agencies Penobscot County Dual Diagnosis Collaborative – 7 agencies M R community Case managers – 3 sessions, 65 people representing 23 agencies Regional Transportation Program – 6 staff Disaster and Vulnerable Populations Conference – 32 agencies Amicus (Adults with Cognitive Disabilities provider in Bangor) 27 staff and clients Children‟s Services Provider Group – 43 people representing 36 agencies Mediators and Guardians ad Litem – 3 sessions (Portland, Augusta and Bangor), 56 attendees Thrive Conference, Lewiston – display table and workshop session to 45 attendees Child Resource Development Centers – 12 attendees representing 6 agencies The Bridge/Youth Alternatives – 6 staff CCME Multicultural Teleconference Series – 20 attendees representing 18 agencies Mid Coast Hospital – 10 attendees Spring Harbor Hospital – 35 attendees Crisis Intervention Team (law enforcement) - 25 Perinatal Nursing Conference - 250 attendees Training was also provided to future contractors in social work classes at Southern Maine Community College, University of Southern Maine, University of New England, and Unity College. 5. Update lists of bilingual workers and interpreters Maine Department of Health and Human Services Bi Lingual Bank 09/14/07 «Num» LANGUAGE: Arabic 1 2 Arabic Arabic «Last_Name » Muse Dragatsi «First_Name» «Department_Name» Reg. Oprtn – Lewiston CDC «Supervisor» «Phone» Amina Alexander 786-5335 287-4466 «Num» LANGUAGE: ASL 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 ASL ASL ASL ASL ASL ASL ASL ASL ASL ASL ASL ASL ASL ASL ASL «Last_Name » AustinReitchel Buscanera Mitchell Davidson Descoteaux Estes Gilbert-Carter Golden Hall Jack McDonnell Owen Pesek Troop Vincent «First_Name» «Department_Name» «Supervisor» «Phone» Mary Ellen Deborah Lorrie June Michele Tammy Wendy Martin Bill Ken Heidi Martha Ashley Meryl Michelle Licensing & Regulatory Services PGC MR – Bangor Dorothy Dix PC MR – Portland OIT Advocacy - Bangor MR –PortlandMH – Farmington MR Crisis – Portland MR – Portland MR – Portland BCFS – Ellsworth Office of Multicultural Affairs BCFS – Portland 287-5816 287-9345 941-4788 941-4329 822-0355 624-9928 941-4751 822-0287 778-8462 822-0310 822-0490 822-0185 667-1600 287-4240 822-2272 «Num» « BELORUSSIAN » «Last_Name » Mitchell «First_Name» «Department_Name» Aspire – Bangor «Supervisor» «Phone» 18 Belorussian Tatsiana 561-4175 «Num» « CHINESE » «Last_Name » Huang «First_Name» «Department_Name» «Supervisor» «Phone» 19 Chinese Jiancheng CDC 287-4068 «Num» « DANISH » «Last_Name » Tyler «First_Name» «Department_Name» ICM – Lewiston «Supervisor» «Phone» 20 Danish Nicole 795-4528 FRENCH «Num» «Language» «Last_Name » Ammari AustinReitchel Barrett Collin Corriveau Cote-Piper Daigle Dallaire Demers «First_Name» «Department_Name» Reg Optn – Lewiston Licensing & Regulatory Services Riverview PC BFI – Lewiston BFI – Caribou MH MR – Caribou Customer Service Rep MR Crisis «Supervisor» «Phone» 21 22 23 25 26 28 29 French French French French French French French French French Mouna Mary Ellen Janet Peggy Brenda Priscille Marilyn Sonia Normand 822-2228 287-5816 624-4692 795-4508 493-4110 287-4265 493-4117 783-6583 287-7181 30 31 French Dostie Pat Environmental Health 287-6721 32 33 34 36 French French French French Dostie-Smith Driscoll Dube Fongemie Jacqueline Michael Lynn Janet Whitten Road MH – Machias BCFS – Ft. Kent 221 State 624-4155 255-1957 834-7722 626-8630 37 French Frigon Christine Riverview PC BCFS – Caribou – BEAS – Lewiston Bureau of Health BFI – Caribou - Commissioner MR – Bangor BCFS – Portland 624-4702 38 39 40 41 42 French French French French French Gagnon Gendron Griswold Guerrette Harvey Peggy Monique Mark Gloria Brenda 493-4073 795-4456 287-5193 493-4090 287-4223 43 44 French French Hayes Lafrance Doris Manon 561-5404 822-2193 46 47 48 49 52 French French French French French Lapointe Levitz Mackechnie Mathieu Orestis Cynthia Julie Pamela Beatrice Doris BCFS – Lewiston Sanford Lewiston Lewiston Riverview PC 795-4691 490-5480 795-4513 795-4484 624-4702 53 54 55 56 57 59 60 61 62 French French French French French French French French French Ouellette Ouellette Parsons Pelletier Plourde Reynolds Rivard Rosenberg Worthington Amy Sandra Jeannette Jenny Rachel Anita Ginette Maria Sandra Portland Fort Kent DROMBO Fort Kent Dorothy Dix PC Substance Abuse Caribou Bangor Lewiston 822-0204 834-7704 493-4036 834-7730 941-4085 287-8901 493-4132 561-4206 795-4521 GERMAN «Num» «Language» «Last_Name » Gregory Rosenberg Tassinari Blanchard «First_Name» «Department_Name» «Supervisor» «Phone» 63 64 65 66 German German German German Scott Maria Anthony Robert Portland Bangor Riverview Augusta 822-0284 561-4206 624-4681 624-7955 GREEK 67 Greek Pappas Nicholas Ellsworth 667-1621 HAITIAN 68 Haitian Beckett Geoff Key Bank Plaza 287-2770 ITALIAN 71 Italian Levitz Julie Sanford 490-5480 JAPANESE 73 Japanese Ramirez Marius Dorothy Dix PC 941-4173 6 LANGUAGE KHMER «Num» «Language» «Last_Na me» Meak «First_Name» «Department_Name » Lab «Supervisor» «Phone» 74 Khmer Sim 287-1706 LANGUAGE Kswahili «Num» «Language» «Last_Na me» Muse «First_Name» «Department_Name » Reg. Oprtn – Lewiston «Supervisor» «Phone» 75 Kiswahili Amina 786-5335 LANGUAGE PALAUAN «Num» 79 «Language» Palauan «Last_Na me» Sweet «First_Name» Hermie «Department_Name» Dorothy Dix PC «Supervisor» «Phone» 941-4258 PHILIPINO «Num» 80 «Language» Philipino «Last_Na me» Ramirez «First_Name» Marius «Department_Name» Dorothy Dix PC «Supervisor» «Phone» 941-4173 RUSSIAN «Num» 81 82 83 84 «Language» Russian Russian Russian Russian «Last_Na me» Berryman Kladov Mitchell Spear «First_Name» Brain Oleg Tatsiana Mark «Department_Name» OIT Portland Bangor Dorothy Dix PC «Supervisor» «Phone» 624-9945 822-2096 561-4175 941-4073 SOMALI «Num» 86 «Language» Somali Somali «Last_Na me» Adam Muse «First_Name» Ahmed Amina «Department_Name» DOTS Reg. Oprtn – Lewiston «Supervisor» «Phone» 287-4539 786-5335 LANGUAGE SPANISH «Num» 89 91 92 «Language» Spanish Spanish Spanish «Last_N ame» Bowden DiMartin i Estabroo k «First_Na me» Maria Lillian Richard «Department_Name» Bangor Sanford Advocate Office «Supervisor» «Phone» 667-1667 490-5445 287-4228 93 94 95 96 97 98 99 101 102 Spanish Spanish Spanish Spanish Spanish Spanish Spanish Spanish Spanish Gerry Greenber g Lane Isakson Levitz Mitchell Libby Matusovi ch McDonn ell Susan Lorie Estela Elaine Julie Tatsiana Rose Rebecca Heidi Rockland 596-4304 287-9251 Houlton Rockland Sanford Bangor Fort Kent Augusta Portland 532-5091 596-4291 490-5480 561-4175 834-7731 287-5387 822-0490 LANGUAGE TAGALOG 105 Tagalog Carmich ael Ruby Dorothy Dix PC 941-4085 LANGUAGE UKRAINIAN 107 108 Ukrainian Ukrainian Mitchell Kladov Tatsiana Oleg Bangor Portland 561-4175 822-2096 LANGUAGE VIETNAMESE «Num» 109 «Language» Vietnamese «Last_N ame» Tan «First_Name » Nancy «Department_Name» Portland «Supervisor» «Phone» 822-0150 6. Request feedback from LEP individuals and advocates CMS Systems Transformation / Access Work Group Meeting March 21, 2008 442 Civic Center Drive Room 3 Minutes Present: Cheryl Ring (Project Manager); Kathy Bubar (Director of Integrated Services), Lisa Wallace (DHHS, Office of Adult Mental Health Services), Meryl Troop (Office of MultiCultural Affairs), Val Ricker (CDC), Claudia Bepko (DHHS/COSIG grant). Guests: Malvina Gregory, RISinterpret manager and Spanish interpreter, Daud Mohamed, member of Somali community; Dr. Osman Hersi, Somali interpreter and head of Maine State Interpreters, and Amy Sneirson, Maine Center on Deafness (by phone). Staff: Larry Ullian, Danny Westcott, Eileen Griffin (USM Muskie School) Item Discussion Decision /Action NA Who‟s Respo nsible NA Date Due NA Intro Cheryl Ring welcomed everyone, including guest speakers invited to present on language and cultural barriers to access. Lang- Meryl Troop invited several guest speakers for a uage presentation and discussion on language and cultural Access barriers to access. Anais Tomeszko, from Mano en Mano, a Spanishspeaking social service agency in Washington County was unable to attend. Meryl had interviewed her prior to the meeting. The Spanish speakers in Washington County did not report substantial concerns regarding access to DHHS services, though the advocate has heard of people coming in to the office rather than calling, or asking the advocate to place the call for them. Letters Mano en Mano‟s clients receive from the Department are usually in English. The group discussed the fact that many Department letters are available in other languages; it is likely that sending the incorrect letter is the result of inadequate staff training. Dr. Osman Hersi discussed some of the cultural barriers in the Somali community. Many people coming to Maine from Somalia find the culture, the language, and the climate so different that they find it very hard to understand everything. He said that it is important to have someone of the same background, age and culture to help translate. For older people, a younger acculturated person won‟t understand enough Report back on plan for commun -icating with office directors Task Group 4.18.08 Item Discussion Decision /Action Who‟s Respo nsible Date Due about the Somali culture to be an effective interpreter. He said that people need a lot of orientation to DHHS services, and American culture. For example, incorrect information is passed on to new immigrants by those who have come before. Some people are afraid to discipline their child because they‟ve been told DHHS will take their children away for child abuse. Children learn to hold accusations of child abuse over their parent‟s head. Children are more likely to speak English, and are therefore listened to first, more likely to be believed, by police. (Sometimes the Englishspeaker, even an accused abuser, is asked to interpret for non-English speaking family members.) Ideally, DHHS would have someone from the Somali community at the front desk, when there are many Somali people in the community. Dr. Hersi also reported that many people are slow to trust their case worker, since turnover is so high and there is no continuity. He noted that the City of Portland has “specialty” caseworkers for each of the large immigrant populations. He said in the absence of a paying someone trusted in the Somali community to provide ombudsman-like services, Somali people will call upon community elders and other trusted people, who are not paid, to help them access the Department‟s services. It is hard for him to do his paid work and to provide this unpaid service to other people in his community. Dr. Hersi noted that many people want access to jobs. He said Catholic Charities used to have someone who could help with this. Now, it‟s not clear where to find help finding a job. The group discussed whether there could be a partnership between the ASPIRE program, the Department of Labor‟s Career Centers, and the City of Portland. The group also discussed a recent flyer offering training in English for job readiness was written in English, creating a barrier for its target audiences. Dr. Hersi said that in the Somali community, that kind of flyer would not get a strong response without the “stamp of approval” from someone in their community that they trust. Dr. Hersi discussed the way public health nursing provides preventive medicine by going out into Item Discussion Decision /Action Who‟s Respo nsible Date Due individual homes. The group discussed the possibility of “mobile eligibility teams” for determining eligibility. Dr. Hersi also noted that the Department needs to pay attention to culturally sensitive processes. For example, giving people a number so that their name can be called in order is confusing for some people. Also, many people do not understand the concept of preventive medicine. They need an orientation to the idea that some diseases can be prevented. Malvina Gregory has experience both as a Spanish language interpreter and as a manager of interpreting services. She spoke about the differences in access for people who do not have legal status; many do not feel comfortable accessing government services. Also, many people are not familiar with the concept of social services and do not think to access them. She also noted that some immigrants have “trickled” into the state over the years and don‟t have a logical mechanism for orienting people to the new culture and environment. In contrast, the federal government has sponsored major resettlement programs for other population groups. She said that people from some cultures do not like using the phone and prefer face-toface encounters. She also distinguished between “high context” and “low context” cultures. American culture tends to be low context; people like to hear a stripped down response to a question: just the facts in bullet form. Other cultures are high context: questions are answered in a larger story with details not necessarily having an obvious direct relationship to the question. Because social services experience high rates of staff turnover, these stories are repeated over and over again, making it hard to build a trusting relationship with a worker that knows and understands a family. The group discussed MaineCare reimbursement rates for interpreter services and that the Department needs to close the loop with provider relations to make sure that MaineCare is reimbursing the full amount. Malvina also discussed the fact that some providers don‟t even submit claims because it‟s so hard to get reimbursed. Amy Sneirson, Civil Rights Program Director from the Item Discussion Decision /Action Who‟s Respo nsible Date Due Maine Center on Deafness, reported that much of what had already been discussed also applies to the Deaf community. For example, people in the Deaf community prefer to get their information from “one of their own.” Many people understand a lot about the English world but are not necessarily of it. She said that interpreter services are now more often available for face-to-face meetings, but not always. She said landlines phones are not a given any more. Many people now use text messaging on cell phones or portable communication devices. Video relay is another innovation: a person can sit in front of a web camera and sign through the internet. An interpreter translates the sign language to English and vice versa. This technology is becoming more frequently used while TTY is less frequently used. There are challenges using voice relay messaging when there is a phone tree. Often the phone tree messages can‟t be interpreted quickly enough to select menu options before being bumped out of the system. Also, there are issues about leaving voicemail messages through voice relay. A caller should always have the option to speak to a person. In-person interpreting on demand is a challenge; need a web camera in order to access video interpreting services. Also, there are firewall issues. It‟s important not to rely on a family member or friend for interpretation. Be aware of cultural differences in the Deaf community. A history of abuse for Deaf people has also contributed to some addiction disorders and mental health disorders. Unfortunately, Amy reports NO access to substance abuse services in ASL. The group discussed the need to be bi-cultural as well as bi-lingual, needing to know taboo topics (e.g., addiction disorders) in certain cultures. A small group will develop recommendations for bringing this information to office directors. Members include: Kathy Bubar, Val Ricker, Cheryl Ring, Meryl Troop, and Claudia Bepko. Next N/A April 18, 2008 9:30 a.m. - 12:00 p.m. 442 Civic Meetin Center Drive, Conference Room 3 g Meetings beyond next month:  N/A N/A May 16th June 20th 7. Review the development and distribution of translated ME DHHS-developed documents, and posting of signs in public assistance offices Local Language Access Coordinators in each DHHS office location open to the public, responsible for ensuring signage is in place: Office Location Coordinator Houlton Paula Scott Caribou Brenda Corriveau Fort Kent Sandra Oeullette Calais Deb Baniszeski Machias Gail Garnett Ellsworth Wendy McCarthy Bangor – Griffin Rd Darlene Emmons Bangor – Pooler Pav. Narda Hanson Bangor – DDPC Ruth Mullaney Skowhegan Larna Marson Rockland Lisa Hall Augusta – RPC Terry O‟Neal Augusta – 442 & 35 Linda Fleury So. Paris Ilona Farrar Farmington Candace Harkins Lewiston (both) Steve Timberlake Biddeford Lori Hill Sanford Dianne Diaz Portland - Lancaster Gerri Connolly Portland – Marginal Helene Moreau 9. Analyze the impact of all procedural and policy changes affecting LEP individuals The Office of Integrated Access and Support, OIAS, updated Core Competency expectations of all employees‟ annual performance evaluation. One of these Competencies will have a positive impact on the quality of services provided to LEP persons: Interpersonal Relations: Shows respect and tolerance for each person. Relates well to others, possesses good listening skills, and demonstrates trust, sensitivity and mutual respect. Recognizes the contributions diversity brings to job performance and creativity Needs Improvement:  Contributes to workplace conflict by actions and/or words  Makes inappropriate comments to other staff  Demonstrates insensitivity to the circumstances of others  Shows disrespect for others by actions and/or words  Openly criticizes fellow employees and supervisors  Routinely makes negative statements about clients, co-workers, programs and management  Consistently questions directives  Is not tactful in oral and written communication Satisfactory:  Shows respect and tolerance in actions and words  Interacts with fellow staff in a professional and courteous manner  Listens well and demonstrates understanding  Recognizes what diversity brings to the office environment  Values everyone‟s contribution  Fosters good working relationships by actions and words  Maintains and develops working relationships in difficult situations with difficult people  Written and oral communications maintains appropriate personal and professional boundaries  Maintains other staffs rights to personal and confidential information  Understands the challenges and abilities all people they are working with for and acts appropriately Outstanding:  Has a beneficial and positive influence on coworkers  Brings diverse groups together  Demonstrates unusual communication skills in dealing with the most complex and difficult situations  Frequent positive feedback from professional contacts  Anticipates barriers Sample policies and procedures promulgated or updated including sensitivity to LEP communication needs: DHHS Web Site Policy and Procedures, Policy # DHHS-34-08 Issue Date: 5/14/08 A. Standards 1. Accessibility: All sites developed by DHHS will be in compliance with the statewide policy promulgated by the Department of Administrative and Financial Services regarding accessibility. This policy is available at http://www.maine.gov/oit/accessibility/policy/webpolicy.htm In addition, all DHHS sites will be designed with low-literacy consumers in mind. Rules for the Certification of Family Child Care Providers, 10-148 CMR Chapter 33 7.5 Right to be free from discrimination. A child must be provided child care without regard to race, age, national origin, religion, disability, sex or family composition. 6.3.5 Compliance with ADA. The provider must be in compliance with Americans with Disabilities Act (ADA) standards. 6.3.5.1 The provider cannot require parent(s) of children with physical, emotional or mental disabilities to furnish the Family Child Care provider with information pertaining to the child‟s disabilities, but the provider is encouraged to ask pertinent developmental questions about all children prior to entrance to ensure appropriate and successful programming. 6.3.5.2 A provider must ensure that all staff are adequately trained and/or have sufficient experience to meet the needs of all children for whom they are responsible. Regulations for Licensing and Certifying of Substance Abuse Treatment Programs 14-118 CMR Chapter 5 Effective Date February 29, 2008 18.1 Policies and Procedures Regarding Access to Treatment. 18.1.1 Adaptive Equipment. There shall be specific policies and procedures governing the availability and provision of adaptive equipment and auxiliary aids. 18.1.2 Interpretive Services. There shall be specific policies and procedures governing the availability and provision of interpretive services, whether spoken language or sign. Changes to Section 5, Resident Rights, of the regulations for Assisted Housing Programs, Level IV, PNMI Facilities 5.23 Notification of Residents Rights. … The provider must accommodate for any communication barriers that may exist, to ensure that each resident is fully informed of his/her rights. Chapter 6A: MENTAL HEALTH LICENSING REGULATIONS Subchapter: PNMI PNMI provider is permitted under the rules to provide certain types of services using appropriately qualified staff. Direct services include, but are not limited to, the following: physician services; psychiatrist services; psychologist services; …; interpreter services ... 10. Reassess the linguistic needs of the affected population: a. Non-English languages that are likely to be encountered Portland Public Schools Multilingual Program Language Minority Chart February 2008 600 590 580 570 560 550 540 530 520 510 500 490 480 470 460 450 440 430 420 410 400 390 380 370 360 350 340 330 320 310 300 290 280 270 260 250 240 230 220 210 200 190 180 170 160 150 140 130 120 110 100 90 80 70 60 50 40 30 20 10 0 N um ber of S tudents 4 9 L a n g u a g e G ro u p s Somali Khmer Spanish Vietnamese Acholi Arabic Chinese Serbo-Croatian Persian/Kurdish 621 210 194 126 99 91 49 45 42 Nuer French Kinyarwanda Swahili Azande Dinka Pashtu Russian Albanian 36 Amharic 32 Thai 19 ASL 19 Polish 14 Lingala 13 Tagalog 13 Korean 13 Tigrinya Madi 12 11 11 11 9 8 8 5 5 5 German Japanese Kurdish Luganda Portuguese Bengali Creole/Pidgin Dari Greek 4 4 3 3 3 2 2 2 Kazakh Hindi Nyanja Panjabi Ukranian Uzbek Bulgarian Icelandic Kosraen 2 2 2 2 2 2 1 1 1 Lithuanian Luo Ugandan Mende Romanian 1 1 1 1 TOTAL 1764 Maine Schools Heritage Languages Language Somali Spanish French Khmer Chinese Passamaquoddy Arabic Vietnamese Acholi Russian Tagalog Korean Persian Dinka Serbo-Croatian (Roman) Swahili Kinyarwanda Amharic Thai German Japanese American Sign Language Pashto Portuguese Creoles and Pidgins, Frenchbased Sudanese Albanian Bulgarian Gujarati Hindi Faroese Polish Romanian Undetermined Creoles and Pidgins, English Lao Tigrinya Miscellaneous (Other) Telugu Bengali Greek, Modern (1453- ) Indonesian Kurdish Lingala Number of Students 1390 526 370 302 268 239 195 191 101 98 64 50 49 33 33 33 32 29 28 27 22 19 19 16 12 11 10 10 10 10 9 9 9 9 8 8 8 7 7 6 6 6 6 6 07-08 School Year % of Languages Spoken by LEP Students 31.46% 11.91% 8.37% 6.84% 6.07% 5.41% 4.41% 4.32% 2.29% 2.22% 1.45% 1.13% 1.11% 0.75% 0.75% 0.75% 0.72% 0.66% 0.63% 0.61% 0.50% 0.43% 0.43% 0.36% 0.27% 0.25% 0.23% 0.23% 0.23% 0.23% 0.20% 0.20% 0.20% 0.20% 0.18% 0.18% 0.18% 0.16% 0.16% 0.14% 0.14% 0.14% 0.14% 0.14% Mon-Khmer (Other) Ukrainian Italian Norwegian Urdu Afro-Asiatic (Other) Burmese Ethiopic Icelandic Nepali Armenian Ganda Javanese Panjabi Sinhalese Twi Bambara Creoles and Pidgins (Other) Danish Estonian Finnish Hebrew Iranian (Other) Kazakh Malayalam Marathi Nyanja Salishan languages Turkish Uzbek Aramaic Azerbaijani Catalan Chinook jargon Cree Creoles and Pidgins, Portugues Czech Dutch Georgian Gþ Hungarian Kusaie Latvian Luo (Kenya and Tanzania) Maliseet Mandingo Mende Micmac Niuean Samoan 6 6 5 5 5 4 4 4 4 4 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0.14% 0.14% 0.11% 0.11% 0.11% 0.09% 0.09% 0.09% 0.09% 0.09% 0.07% 0.07% 0.07% 0.07% 0.07% 0.07% 0.05% 0.05% 0.05% 0.05% 0.05% 0.05% 0.05% 0.05% 0.05% 0.05% 0.05% 0.05% 0.05% 0.05% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% 0.02% Serbo-Croatian (Cyrillic) Shona Tahitian Tivi Total Counts as of 04/01/2008 1 1 1 1 4418 0.02% 0.02% 0.02% 0.02%