DCF Advisory Committee Meeting June 15, 2011 Crown Plaza Airport Hotel, Orlando, FL

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This transcript was created in real time by a Certified Real-time/CART Provider. It has been roughly edited. It is not a certified legal transcript. It is intended for use by the recipient only as notes of the proceedings.

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>>RICK KOTTLER: Could I get everyone's attention? Could we get seated? Okay, let's get started. If you haven't noticed, we don't have microphones. Somebody didn't get the memo. They're on their way, but in the meantime, we're all going to share a microphone. So I'm going to start off with the introductions, pass the microphone around, and I will go down and sit by Bob and take it back when it's done. If everybody would take a second and explain who you are and why you are here. Debbie is our newest member, and she's going to be representing the deaf on our committee. She brings a lot of experience. I have known her for many years, and I hope you all will welcome her because we really can use her right now. For the record my name is Rick Kottler, I'm the director of Deaf and Hard-of-Hearing Services of the Treasure Coast in Jensen Beach and the chairman. >>Good morning. My name is Chris Recinella with the Department of Children and Families Development Unit. I have been on the team that has been developing the curriculum for this training. >>My name is Denise Hunter, also from DCF on the training team with Rick and Marsha. >>MARSHA RYAN: Marsha Ryan, on the training and development team as well. >>Good morning. I'm Michelle Riske-Morris with Justice, Research and Advocacy, and we are the independent consultants. >>Good morning. My name is Carolyn Dudley, assistant staff director for the Department of Children and Families Office of Civil Rights. >>Good morning, Merlin Roulhac, Department of Children and Families. I serve in the role of project manager for the settlement agreement between DCF and HHS. >>Yasmine Gilmore. I assist Merlin on this project. >>Good morning, my name is Marc Dubin; I'm an attorney with the Center for Independent Living of South Florida and serve as director of advocacy there. >>Good morning. Lois Maroney from St. Petersburg. I'm a licensed mental health counselor in private practice. >>I'm not going to use the mic. Hello, everybody. My name is Debbie Lauricella. I know you are expecting me to speak, but I don't do that. I will be using the interpreter. And I am, of course, a deaf person. I use ASL, that's my native language, my first language. And I just love ASL. It's a beautiful language. And my mother and father are deaf. My grandmother is deaf also, so they gave me that language and I pass it on to the next generation; I have a deaf child also. We have four generations; strong language of deaf in my family. And I went to a deaf school and I have gone to different colleges. But I haven't finished quite yet. I have been to five different colleges, haven't graduated. Just haven't finished yet. And I have sat and read English, and it's quite 1 | Page

different. But Sign Language and a Sign Language community, that's where I belong. And what I am doing here? I am here as a deaf advocate for the deaf community and here to support all of you, as we definitely need that out there. I was the director for a Deaf Service Center in Lakeland a while ago, until I became a mother of a deaf child. His father passed away and he couldn't be alone so I had to take care of my child and it was a very rough time for me because there was really nothing in this state that could offer something to me as a deaf mother. There was nothing, absolutely nothing. I struggled a lot with that. And my mother had Alzheimer's, so the support services here for the deaf people, my goodness, they had no idea what dementia was, Alzheimer's was. I had to live my way, go through my struggles. So I had to quit my job so I could focus on my mother. They had a deaf assistive living facility there in (city) because they had nothing here. So after my mother was there, I retired so I could just be deaf. So I am so happy to be here, honored to be working with you to improve these services for the Deaf and hard of hearing. >>Hi, my name is Susan Herring. I am from Pensacola, Florida, and I am on the committee as a deaf blind consumer, so I put in my little two cents' worth regarding that. >>Good morning, everyone. I'm Cindy Simon. I represent the audiologists here. And I would like to welcome Debbie, and we are really happy to have you. >>I'm Shana Williams, psychologist and director of social services for the Center for Hearing and Communication, Fort Lauderdale, Florida. >>Hi, I'm Terri Schisler, and I represent the Florida Registry of Interpreters. >>Hi, I'm Valerie Stafford-Mallis, I work for the Department of Health, and I do training, education and outreach on behalf of the Florida Coordinating Council for the Deaf and Hard of Hearing. And I am really, really happy to have Debbie Lauricella here to represent the culturally Deaf point of view in our deliberations. Thank you. >>Good morning. I'm Kim Gaut. I'm the executive director of the Deaf Service Center in Charlotte County. >>I'm Bob Fifer. I'm on the faculty at the University of Miami in the Department of Pediatrics, the director of audiology and speech pathology at Mountain Center for Child Development. And I wear a couple of other hats -- former president of the board of trustees for the Florida Deaf Services Bureau, and consultant for the Florida Department of Health and Children's Medical Services and also AHCA. >>RICK KOTTLER: Okay. I want to introduce Gayl Hardeman as our CART provider, and our four interpreters, Judith Britt, Shonna Magee, Jena Szikney -- did I get it right? -- and Nancy Wilbanks. Since I do have the floor, one thing we don't have, obviously, is microphones, so we are going to be passing the microphone. I'm not sure how you guys are going to do your presentations, but if you are going to take questions during it, then I'll just walk around with the microphone. Is that what you are planning on doing? >>MARSHA RYAN: That's fine. >>RICK KOTTLER: Okay. When you do use the microphone, if you put it too close to your mouth, Gayl's not going to understand what you are saying. So use it a little bit wisely. Last month when I walked out of here I thought this was wonderful. I have been in a lot of things with the Council and different commissions and different committees, and, you know, we've obviously been given an opportunity to make a difference, and this group is so diverse, and I wondered whether it was ever going to work, and everybody's pulling for the same thing. And I'm not just talking about the committees; I mean the DCF people and Michelle. I just couldn't be prouder to be part of this, and I want to thank you all very much for what you do, because it's a wonderful thing. On that note, Marsha, you have the floor. >>MARSHA RYAN: Okay. I appreciate everyone's patience in getting out these documents. It is getting so voluminous -- 2 | Page

>>RICK KOTTLER: I made a faux pas. Has everyone read the minutes? They were distributed. Yasmine added some people who were left out. Does anyone have any other changes to the minutes? Could I have a motion to accept the minutes? Cindy made the motion to accept, Shana seconded. All in favor? [Motion carried.] >>RICK KOTTLER: Okay. Now you can have the floor back. Thank you very much. >>MARSHA RYAN: Okay. Again, we appreciate your patience and your getting these documents late Friday, having to review them on the weekend. We tried to think of every possible way to get them to you, so we finally gave up and gave you what we could in the print. The PowerPoints we gave you this morning. I saw Chris running around this morning with CDs, and we're hoping that those will be -- you will be able to download them to look at them, view them once you are able to get them to your home and are able to look at them. We do have them here, and all of the documents, if you want to see something specific. We are loaded and ready to go. If you want to reference anything, we have it with us. So I brought a great big thumb drive. We've got it! Okay. As far as the process for this morning, I thought what we might do is just use the document that was the comments spreadsheet to go through, and not go through the training detail over and over again but go through the comments. We tried to compile these in groups of topics. They are not all in person order. Some of them are repetitious, had you the same comments. So you might see some that are repetitive, but we tried to weed out some things that are repetitive. So if you see where you might have made a comment but it was already taken in some other person's comments, if that's acceptable, we have moved on with that. Okay. I guess what we'll do again is, if you have comments to our comment on that line, then if you'll just give us the high sign, we'll get a microphone to you. Okay. The first one, Cindy Simon? Let me go back. Rick, do we really want to go through each one of these? Have you all had time to look at them? You want to go through them individually? >>RICK KOTTLER: No. I would say we have comments, let's break them up as we go on a page by page basis. >>MARSHA RYAN: Okay. We do have the pages numbered. Don't have the columns numbered but we can guess what that is if you will give us a second. >>RICK KOTTLER: Okay. I have a question on the first page. Right at the beginning where you talk about role playing, how is that going to be accomplished? You are talking about role playing between two people, and I understand that part. But one of those people is going to be maybe the deaf individual. How are they going to role-play something they don't understand? That's my question. >>CHRIS RECINELLA: I will respond to that. My name is Chris Recinella. The role play, the purpose of that activity, is correctly filling out the forms, understanding what the fields are, understanding what the procedures are, and Michelle has spoken to us, that's something that needs to be focused on, that the DCF staff need to know how to fill out the forms. So the purpose of that activity, it may be disengaged from some of the information earlier on regarding Deaf Culture or the different identities, but what we want is for people to come in and know -- we will give you an example. Denise and I just finished a training. We are paired up. Denise is going to be a DCF staff worker, let's say in her normal job she works for Access. So I'm going to be the client coming in who is coming in for help with the Access program because she has that program knowledge. I will say I am hard of hearing, I need an assistive listening device, so we will role-play what that interaction looks like filling out forms. That's the purpose of that activity. Does that answer your question, Rick? 3 | Page

>>RICK KOTTLER: Yes. >>MARSHA RYAN: Also, I thought that I heard a little something different in your question: How will you know how to role-play someone who is hard of hearing? >>RICK KOTTLER: Right. >>MARSHA RYAN: We will never know exactly what it feels like from the other person's perspective, because we're not there. We understand that. What we will do is, this is almost like a double test of knowledge here, because we've gone into the culture background and examples of some of the ways to recognize deaf or hard of hearing or -- and when you ask and you need assistance, we've talked about some of the cultural differences in the different and hard of hearing culture. So some of that will already be there. But we will have notes. When we are doing role-play, you will have a little card that says you are hard of hearing. This means that you understand -- if in that case we are going to have in the role play, they might have a bullet that says, you understand English, you can hear, and you can read and write English. You do not understand Sign Language. We may have a bullets that would describe what it is that his case would be as the client. Does that help? >>RICK KOTTLER: Bob is first. >>ROBERT FIFER: I apologize for you all for not having been here the last two meetings. Considering where I was and what I was doing, I would have much preferred to have been here. Trust me. I have a question and a possible suggestion. For the classroom training or the face-to-face training, will that consistently be in a common location? Or will that be regionalized? >>MARSHA RYAN: It will be all over the state, in separate places. It will be regional. >>ROBERT FIFER: All right. I have a suggestion for your consideration, and that would be to have someone from DCF staff -- if you cannot find anyone from the deaf and hard-of-hearing community to come and actually play the part as a professional actor, so to speak, then my suggestion would be to have someone from the DCF staff be a single client consistently. And the reason why is this has been demonstrated to be effective in medical school training programs and many other training programs where if you have someone who is can consistent and in the client -- or, in our case, the patient role -- that person gets better and better and more realistic as time goes on. My concern is that if you give this card to someone who is being trained, they will have no clue, and the role-playing will be much less effective than if you have someone who is real from the community or someone consistent to be the person role- playing in that particular role. >>MARSHA RYAN: Thank you. >>MARC DUBIN: As you role-play, I was wondering, how are you getting feedback on how the role-play is going? Are you utilizing anybody from the deaf or hard-of-hearing community to give you feedback on how realistic the person playing the role of a deaf or hard-of-hearing person is? And do you have any staff in DCF who are deaf or are hard of hearing whom you could utilize? And if not, do you plan to use any members of the community who are deaf or hard of hearing in these role-plays? >>MARSHA RYAN: We have not planned to have the community person, an advocate from the community, to play that role or to be in that role for the role-play. We had not planned to do that. What we had planned in the curriculum was to have two staff that were in the room, if it were the Single Points of Contact or the direct service, to take those roles. That's what we had planned. We could certainly take that into consideration, and the community advocate will be invited to the training, and hopefully will be there, and can provide some information during that time when they're there and give some insight to. Again, we certainly were having advocate representation but not specifically planned to do the role-playing. >>MARC DUBIN: I'd also ask whether you have any DCF staff who are deaf or 4 | Page

hard of hearing. >>MARSHA RYAN: I believe there are folks in the staff who are Deaf and hard of hearing. We do not have any on our training staff, and I don't know that we would have anyone that is currently in the department be in the training. I don't know; we haven't taken a survey of those spots. I don't know, maybe Carolyn can speak to that. Are there any deaf or SPOCs? She says that she wouldn't know. >>RICK KOTTLER: Debbie's next, and then Bev. >> >>DEBBIE LAURICELLA: I'm a little bit confused about the role playing. If you are not deaf, how do you know how deaf people should feel or act? You should have a deaf person who can understand what we look like, and deaf and hard-of-hearing people are different. So that's the only thing that concerns me, you know? To have a real, live deaf person that is there, involved in the training, and working with that point of contact, they should be able to explain in depth our perspective. So, you know, you are giving a card to somebody, they are kind of, you know, in make-believe, acting what it feels like to be in my shoes. So that's really my own concern is to really please have a real deaf person that's in there, you know? Because that way, they can be creative and lead the people. If you have somebody who is hearing they may lead them in the wrong direction and that will cause more problems later on down the line, so if you have this training with a deaf person first, then the results should be fine. >>RICK KOTTLER: Okay. Do you have a comment to that? I think we have to make sure we are staying on the same track. We are talking about doing this to get forms filled out, and that's the important part of this whole thing. Valerie? >>VALERIE: Hi. This is Valerie. I am wondering why we would not want to make sure that the trainers themselves are trained to play that role when necessary for filling out the forms. They're always going to be at the training. I mean, I agree with Debbie Lauricella that it is best to have a real live person who is deaf or hard of hearing to play that role, but in the event that that's not possible, then the trainers have been trained to do that. >>MARSHA RYAN: Yes. Actually, logistically, for training, I would say that that would be a nightmare for us. I mean, just logistically. Not practicality. I think practically, I would agree that it would be best to have the real deal. And to show that and actually see that in action. That's always the best. But I don't think logistically -- we have scheduled over 200, actually -- let me consider all this -- we have scheduled or are anticipating scheduling 262 sessions across the state between July the 12th and December the 31st. 262 one-day trainings. That's going to go around in the state. Logistically, getting a, quote, real deaf person in that training is going to be very difficult, because there are oftentimes persons who are hard of hearing but are not deaf, and as you would know, and I certainly won't instruct you, but there is certainly a gamut on that spectrum there. There's a lot of difference. And it would be best to have someone. We are planning and attempting to have an advocate at each one of those sessions, but it would not be to do the role-play, but would be there as we did in the demonstration where Valerie played the part of our community advocate in that last month; she was open to questions, any questions, and she even offered I believe at that time to take off her implants and let people look at them. I don't think anybody took her up on that in that group. But certainly being open to that in the session, it would be a different place. It wouldn't be specifically in a role-play. But that's our plan. And if you see us venturing from that we could consider that but I think it would really put a burden on the logistics of trying to make that happen. >>RICK KOTTLER: Susan? >>SUSAN HERRING: Thank you. I was just thinking. I have not experienced this before, and I have heard that there are products out there called the Simulator, and 5 | Page

they imitate or try to demonstrate for an individual what it's like to be deaf-blind. I know the Helen Keller National Center has this sort of equipment. And I am thinking we could find more about those and maybe those Simulators could be used to help demonstrates to these people that are in the training program what it's like to have vision loss or hearing loss or just a hearing loss. And I don't know if it works in degrees or just gives you an idea. But it may not be as perfect as having an actual hearing loss person playing that role, but I think it would help for these people to understand or get a little inkling of what it's like to not be able to hear, or not be able to hear and see, or to have some sort of idea of what they are trying to do. If you are interested in getting that information, I would be happy to send you contacts of somebody who could give you more detailed information on how this equipment works, and how to get it. >>CHRIS RECINELLA: If I may respond to this. Thank you, Susan. We have downloaded the National Institutes of Health "Hearing Loss Simulator" program and have added to the presentation a Hearing Loss Simulator. I worked with Cindy a little bit to verify that it's a good program. So there is a clip that is played with both foreground and background noise. There is a man speaking and there is background music. It goes through and actually has the decibel loss at several different bands of frequency and adjusts accordingly for those different levels of hearing loss that we go over in the training with the mild, moderate, and severe. The other thing we have added is, we have excerpts from a couple of FTRI videos that add some brief interviews with individuals. There's a deafblind individual, there are some culturally deaf individuals using ASL. There are some hard-of-hearing individuals using the different services, and so those interviews, I think, give a great demonstration of what interaction with that community looks like. We are working with -- I have called the federal VRS. They have bounced me to the Sprint VRS, who has finally bounced me to the Z. And the executive account manager of the Z for the South and I have been speaking this week, and he is going to be sending some video that they have with their outreach program with the VRS, so that's in the mail. We will see if it is usable. But that's also there. So know that that is in process. The other video we have here today, and at a break or if there is an appropriate time -- we don't have sound hooked up to the laptop, but we can show you what that video looks like if anyone would like to see that.

>>ROBERT FIFER: This is Bob. Given the scenario that you just described, the trainer is going to be the vital key to make the role-playing realistic. The trainer is going to have to spend time with members of the community in order to develop some level of understanding in order not to have role-play move into what I call, for lack of a better term, the area of silliness. Because individuals who have this role thrust upon them may feel ill at ease, especially in the beginning. And when you feel ill at ease, there is a tendency to be a little bit silly, because you are trying to get the nervousness out. And it's going to be extremely important that this be as realistic as it can be, given any logistical constraints. So I come back to my earlier point -- consistency of the role-player is going to be absolutely essential. Now, the DCF staff intake person can be someone who's from the audience being trained. And have a critique of what the person did right and what the person did not do quite right, and what the person did that was really not right. As a result of that -- and that can also be a part of the learning experience itself, but the role-player is going to be critical to the entire process. Moving ahead just a little bit to another related topic, and that's the ALDs. In my experience, it's going to be essential to let people who are not familiar with 6 | Page

TDDs, for example, or amplified telephones or CapTels or whatever, play with them, to the extent that you can in that office or that classroom-type setting, so that they have some familiarity and they're not intimidated the very first time they are called upon to use these -- when a client comes in, or for a form fill-out for care, whatever -- that will be necessary for communication. So familiarity there will also be a key element. >>MARSHA RYAN: Point well taken. What we will do is, we will look at the role-plays and make them as authentic as possible within our resources. We can be very creative in trying to do some things and we will try our best to be as authentic as possible. >>RICK KOTTLER: Lois? >>LOIS MARONEY: I think role-playing is really important in the education process. I think people learn a lot. But I do have concerns about that some of the advantages we are going to lose not having a person who is really deafened, deaf or hard of hearing being at the other side, because I'm afraid that some of the acting might continue to perpetuate the myths about hearing loss or deafness. So that makes me a little bit nervous. I would like to see it videotaped, have it done one time, have a good representative of deaf, late-deafened, hard of hearing, deafblind, and show that around. >>MARSHA RYAN: That's a good comment. Actually I think we are on the same brainwave here, Lois. I have written down a note, a video of the role-player, and if that's possible, if we could do that, and then have the participants to come up with the example of how to do that. And as a note to Bob's comment, I understand that it can get in the training room and in the training lab, if you want to look at it that way, that people who are very uncomfortable can get to the silly. But we would much rather them work through that in the training lab or a training situation where we can make corrections and make those -- make it come out right, than actually when it happens with a client or a customer. So going through that stage of becoming comfortable with their responses, that's the whole point of the role-play, is for them to become comfortable with exchange and having effective communication with their client or customer as they are filling out the form, so they can get that information. So that's the point of the role-play. And I think that having like Lois said maybe a tape of several different roles, whether it's a person who needs an interpreter, whether it's someone who prefers a hearing device, listening device, whatever that role would be, to put on the form, I think that that might capture your need and your concern for it to be as authentic as possible. And it would be on video. That would be, I would think, more logistically possible than having the person in the room at all these 262 sessions. And it's a very short -- at this point, it would be a short exercise, a short activity, in comparison to the entire training. It wouldn't be an all-day thing. It's a very short exercise. So ... >>SHANA WILLIAMS: A couple of questions. When we were talking about equipment, are each of the train the trainers going to have PockeTalkers and Ativas with them so they can demonstrate, touch them, feel them, so they can get a sense of that? Will they have actually seen AVP so they know what that looks like? And then on the role-play issue, I think this is one section where -- I like the video idea -- this is one session for filling out forms, but role-play in its entirety helps person to understand the material. And I think the reading of law is not as clearly demonstrated and not as effective a learning tool. >>ROBERT FIFER: Just a follow-up comment. The individual playing the role, the deaf individual or hard-of-hearing individual, et cetera, will be the key. That person will be the key to keep things out of silliness, and definitely on track. And that person has to have the ability through prior contact with members of the community to really immerse himself or herself in that role. The people being trained are going to be nervous. And they may move into the area of silliness, you know, just by virtue of their 7 | Page

nervousness, and it's going to be the role-player's responsibility to bring them back to reality and make it serious again in terms of -- I need help, you are here to help me, let's focus. But the key to it all will be the individual playing the role of the person who is going to be the client or customer. >>VALERIE: Hi, this is Valerie. Thinking about role-plays and the experiences of other disability organizations have had with that, they do open the disability organization up for criticism from the persons with the disability when role-plays are used. I think you have heard some of those concerns here today. If the DCF decided they didn't want the to place themselves in that position, an alternative would be to do the video thing like we talked about with people with real disabilities going through the forms and the trainer facilitates the discussion afterwards, what went right? What were the skill sets? How do you apply that to learning? And draw the participants in that way. That's the approach that we used for our legal systems access for persons with hearing loss training that we do for law enforcement officers. We actually videotape real live law enforcement officers conducting law enforcement encounters with real live deaf people and then afterwards, the trainers elicit that discussion and point out those relevant skill sets, so that way we weren't involved in that role-playing which has proven offensive to many people in the disability communities despite the well-meaning intentions of the people that do it. >>CHRIS RECINELLA: And I think that's a great point. We're taking notes of everything you are saying here. I want to come back to Shana's question about the assistive listening devices. Those will be in the SPOC trainings so that they can see and touch and feel those. >>CINDY SIMON: I just have one quick question. Would it be helpful if you know you are in one of our areas to let us know when you are going to be here so we can make it, we can come in and watch what's go on and maybe assist with that or maybe you could find someone in the community that you could use for the role-playing? >>MARSHA RYAN: We are actually inviting for every session -- we haven't actually done it yet; we need to have an approved training plan and have the training, know what we are asking them to do, finalized, which the deadline is the 28th of this month before we actually contact the advocacy organizations. But in the training and the settlement agreement, we are asking representatives from advocacy organizations around the state to be in those trainings and to assist and to have a part of the training and to be there to answer questions, those kinds of things. So that is part of the settlement agreement. We are matching that. I don't have the logistics of that at this time finalized, but that's certainly what we're doing, yes. Actually, I think that we discussed this adequately, that we will make every effort to look at the role-play and to honor your feelings here and your concerns, so we will move with that. And Shana, you I think you had another one? >>RICK KOTTLER: I have one too. And this isn't a question. Well, it is. I know your drop-dead date is July 28th? >>MICHELLE RISKE-MORRIS: No, June. >>RICK KOTTLER: Okay. But after that point, is this going to be a dynamic training program? Can it be changed after that point? Or can it be approved as you go along? Or is it cast in stone? >>MARSHA RYAN: I think that the definition of training is that it is dynamic. We will not -- as we find things that don't work, we make them work better and we will adapt and work better. We will also hopefully be able to add more opportunities. I don't know how much more we can actually stuff into the training that we have now. As you start doing activities and start adding more and expanding that out, it can certainly get bigger and bigger. Not to say that you don't need more information, but you don't have to get it all in one day. We've realized that as adult learners, you can only take in so much in a day anyway, so what we would like to do would be to develop some follow-up products that might be online or might be what we call blueprints for SPOCs to use when they are talking with their direct training service employees locally. 8 | Page

It would not be part of that training specifically but we could add more information and hopefully we'd have some -- we would hopefully be able to add some other enhancing things. Like maybe have a visit from a local -- have a forum for staff to come and talk to someone from the advocacy organization in the community. Our whole point in our training plan is, we put forth advocacy organizations to be there to develop a relationship locally with those providers and the providers of the services that DCF have, whether it's a DCF employee or a contracted provider, so that relationship is built, and certainly that would be encouraged and would have other opportunities throughout the year. It's not just one event, as I see it. Does that answer? >>RICK KOTTLER: Yes, that's fine. >>SHANA WILLIAMS: How is the process of getting the reading levels on the forms and materials gone through? We had talked about that we wanted to make sure it is on a 4th or 5th grade reading level. And Michelle and I were talking that it might be useful to have a deaf speaker look at the forms. But is the reading level being addressed? >>This is Merlin. I have sent some of the forms to our communications department with a request for a review. I have not heard back from them to this date. But that is in the works, that we are pursuing that. >>RICK KOTTLER: Michelle? >>MICHELLE RISKE-MORRIS: I just wanted to add that one of the things of the training plan we are encouraging is, we go out and do site visits. We are also getting responses from the advocacy services that are going out in the next month or so as well as assessments that the community has reviewed. But those are ongoing processes. We are gathering information from the SPOCs, from the organizations. We are also doing focus groups, incorporating them into our site visit. One of the things with the training plan is, I encourage them when we go out to get information, they start to incorporate that into additional trainings in the future. So it will be an ongoing process. And as new things arise, new difficulties or areas that we didn't think are problematic but now he we see are problematic, that they will take that information. So the refresher training will not just be the same training that was developed here. It will be constantly an evolving process to address outstanding issues and needs that are arising through this accumulative act of monitoring as a requirement of the settlement agreement. >>RICK KOTTLER: Moving on to page 2. Comments? Terri? >>Terri Schisler: Hi. You mentioned that you were working with ZVRS and some other VRS agencies to get more information and you are incorporating some of the material into your training. Correct? >>CHRIS RECINELLA: If it's propose. >> >>TERRI SCHISLER: Okay. I have several comments that I submitted to you guys and several of those were marked as being referred to OCR. And so I was wondering if you've gotten any further information on those since that time, if any of those suggestions or comments have been deemed appropriate. >>CHRIS RECINELLA: Anything marked -- and I will clarify this -- anything marked along this document is forwarded to the OR. By and large, those dealt more with policy issues, not dealing directly with the training material or activities, some of them have been under review. Your document was one of the first ones to go over there because it was one of the earlier ones sent in to us. Carolyn would have to speak to where the staff is at reviewing that and approving that. I don't know. >>TERRI SCHISLER: My main comment here is just generally about VRS and how it is being treated in the training. I mean, you guys have done an amazing job and there is so much here that you have included but making sure that your staff are clear on the use of traditional text-based relay services and video relay services, and I also did a little bit of research -- haven't really gotten any confirmations. Went onto the FCC 9 | Page

Web sites and looked at their definitions of TRS and VRS and how they might be handled by users, like DCF or other entities that might be interacting with the deaf community, and I just wanted to make sure that -- I have not found any reason why VRS would not be a viable alternative for communication and the training materials are heavily weighted toward TRS. Video relay service is a TRS service. It is funded differently and it is operated differently, but it is still a TRS service. And so, I just was wondering, you know, waiting for OCR to respond to those procedural or policy issues. I am anxious to see what they might respond but if within the training materials this was -- you know, this is something that I would like to see, make sure that we have clarified that, and there's confusion business the use of 711 and TTY-TDDs, and the difference in interacting with someone who is calling through a TRS, text-based relay, versus a video relay service. And that's the training part that I would like to see clarified. >>CHRIS RECINELLA: And that was confusing, in what you guys saw last month. There was what I will call TRS, the 7-1-1, the FTRI programs. Then the VRS, VRI, and that confusion. We are not introducing VRI and VRS together anymore. Okay? There was a point, the legality issue, had kind of combined them. But it gets too confusing, and we got in mud. So VRI is now introduced just with interpreting services. You have just like CART, just with interpreting services, you can have face to face or remote. That's what the point needs to be, really. And I think it's much clearer now. With the VRS, here's the thing. Because of FTRI, it's much easier to gain access to training materials, to images, to information on the TTY, the voice carryover, those services. I have been contacting several VRS providers. Perhaps -- this is my guess -- it's corporate; it's a little different. It's much harder to get things that "I'm promoting my company and this is how this works." So I am hoping this video that what Z is sending me is just confirmation about how a video phone call works. My conversation with that representative was actually a VRS call, so it was great for me to experience that as well. It is different from the 7-1-1 phone calls. I am hoping that it is the FTRI video -- we will show the difference between the identity and cultural. I think we get both of those captured in that. And I would love to have a video. I really believe if anyone here knows of any demonstration videos on the video phone system, please send it our way. It is really hard to come by. But we have set it apart so it is no longer a fly-by on the VRS, but we are going to stop and talk about it a little more on this time around. >>TERRI SCHISLER: The other point I would like to see in that revision is to really clearly delineate that the people who use the text-based service and people who use the video relay service are going to be two different populations for the most part. So if their primary focus is text-based relay, then they still don't know how to deal with the Sign Language population. So we want to make sure that they see them both as viable options, both as equal services, both as provided nationwide. So what we are seeing in my field -- and I work with VRS full time, and I can work with my company to see if they can get you some materials, see what I can do -- what we are seeing is many companies and some government agencies, when a relay call comes in, it is automatically shifted to a text-based relay service or shifted to your TTY department, because that's the policy that that company has put in place. And video relay service has not been readily accepted in certain businesses or certain fields due to privacy concerns and maybe -- I'm not sure what other reasons. But we make calls every day to companies, and the minute somebody says, "Relay" when the operator has to announce that's a relay call, when that is said, sometimes even without a response, that is transferred to a TTY department. That effectively ends the conversation, because I am not a machine. You should let your staff know, oh, relay call, transfer call -- that is something you cannot do. You have, in effect, cut the line, and you are not allowing anybody access through a phone line. 10 | Page

I just got an e-mail this week, through the Florida Coordinating Council, that the D.O.J. has a settlement agreement that came out last month against Wells Fargo for that exact same action. And in that settlement agreement, that outlines those procedures that that is what is happening with that particular company. And the D.O.J. agreements are right there saying some of the same things I have put into my recommendations. >>CHRIS RECINELLA: Thanks. I will be brief. One of the two videos we have excerpts from is "Don't Hang Up, We'll Do Business." So the intro that is played shows people hanging up -- no, thank you; take me off your list; we don't have time. So I think that video does a really good job of saying when you hear, "Hi, you are receiving a relay call; have you received a relay call in the past?" -- and they also have those demonstrations of the calls taking place -- my hope is that they will really get that down. We will look at the language of the instructor guide and make sure that we say you have seen voice carryover, you have seen TTY, here's another relay service, and make sure that that's crystal-clear, that this is another and equal type of service. It's not a ( ) but it's an equal type of service, another relay service. So we will check on that. Thank you. >>VALERIE STAFFORD-MALIS: Regarding the D.O.J. settlement agreement with Wells Fargo, one of the beauties of these things is that there are model policies that actually have the language and the instructions on how to come into compliance. So when I get home I can send you a copy of that model policy. And it'll pretty much lay out for you language that you will want to put in your trainers guides. >>MARSHA RYAN: Perfect. >>RICK KOTTLER: Lois? >>LOIS MARONEY: Just keep one thing in mind that relay calls. Not all of ( ) will be identified as a relay call. So when I use the relay service there is no mention at all that I am deaf, so in your training be sure that people understand that, that you might have calls from somebody and they are deaf, but you won't know that. >>CHRIS RECINELLA: Right. >>MARSHA RYAN: Duly noted. Thank you. >>RICK KOTTLER: Anything else? Okay. On to page 3. Nothing? Page 4?

>>MARC DUBIN: On Page 4 they are saying they are training the staff on relay calls. Are they also training the staff on TTY and video relay calls? >>CHRIS RECINELLA: The reception of the video relay call, as Lois said, you know, sometimes is identified, sometimes not identified as a relay call. I think that that is adequately covered in the instructor guide as it is in this new revision. As for receiving a TTY to TTY message, we don't have that currently in the materials. If that's something that needs to be looked at, we can discuss that. >>MARC DUBIN: Well, I will leave it to others to say what they feel about that, but my view of that is that if someone is using a TTY and they are calling your TTY number directly or one of your partners' TTYs directly, there needs to be training on how to use a TTY. Not interrupting people, being able to do Go Ahead and all the rest of it. And if your staff and partners are not being trained, I would suspect that that would cause some problems for some TTY users. That's my view. >>CHRIS RECINELLA: Forgive my ignorance, I might be ignorant in this situation. When you are discussing TTY to TTY phone, you are speaking without the 7-1-1 communication assistance? >>MARC DUBIN: That's correct. >>CHRIS RECINELLA: Okay. We do discuss the turn-taking and how that works with the TTY-TDD phones. So the appropriate etiquette and Terri, the great language is the turn-taking, thanks, really like that. And we go over that. And it's in the offices where those TTY phones are set up. I know our Office of Civil Rights has one set up. Carolyn might be able to speak to that. 11 | Page

In the offices where those have been set up, has there been a prior training for the staff on how to use those when communication comes in? It's not part of this training. I don't know if it's been part of a prior training. >>CAROLYN DUDLEY: Yes. >>CHRIS RECINELLA: Carolyn says yes, that has taken place. >>RICK KOTTLER: Bob? >>ROBERT FIFER: One of the key things on a TTY is to simply let them listen to what those tones sound like because there will be some offices that do not have a dedicated TDD or TTY phone. They will have a portable, where they answer the phone, they hear this strange sound, and then they have to recognize that as a TDD communication line, switch on their device, and then put the hand set down in the cradle. It is a really weird sound the first time you have ever heard it. And it sounds like, you know, somebody is coming from Mars, because it is so unusual in the combination of tones that come through. So to have them just listen to that type of call communication, to recognize the sound of a TDD, will be of tremendous assistance, should they have a non-dedicated phone in the office. >>RICK KOTTLER: We get a lot of hang-ups on those calls. It sounds like a fax machine, for lack of a better term. >>MARSHA RYAN: Okay. >>RICK KOTTLER: We will move on to page 4. >>LOIS MARONEY: There should be more emphasis about CART. I am looking over to -- I love that comment, and then I am looking over to the other side, and I see noted for possible future supplemental training. And I'm starting to feel worry coming up from my body. I feel like, oh, no! So I thought I would ask for facts first. What do you mean and why is it not being included? >>MARSHA RYAN: Okay. We have some information in the training on the CART. But to go into -- we're not doing a demonstration. Is that correct? Do you have answers that you want to speak about? >>CHRIS RECINELLA: That's correct. >>MARSHA RYAN: We don't have a demonstration or trial or showing of that in the training. We would like to be able to get some video possibly of other assistive listening devices and other tools that could be used. We don't have those at this time, but we could certainly add those as supplemental. To continue to go into every device and go over every training for that -- we are giving brief information so they know what it is, explain it briefly, but then we are moving through in the curriculum. So we have put here as our response for supplemental training, we would like to get other video in the future that can be added as a supplemental information on devices and auxiliary aids, possibly online, that people can go in and look at. So we at this time don't want to add additional information, if possible, to the current training, but to spend the time that we have on filling out the forms and actually what their responsibilities are for getting the information and providing the services; and having a general knowledge of what CART is. >>LOIS MARONEY: At the next meeting we are going to be having a CART provider -- we are working on that. I am working with two CART providers in my area. I can't have other advisory board members invited to that because of sunshine so I am taking the lead for that with two other CART providers and going over policies and procedures and seeing what content we need on CART. I think I have always been a strong advocate here to have the CART, and I think about ten years ago -- I knew no sign, no hearing at all; speech reading was about 25 percent, because I had no residual hearing. And if I went to DCF, I would need CART, period. So I just want to be sure. A lot of times people think, oh, just Sign Language is the only thing that's needed. So I want people, when they leave there, to truly understand about that population and that they need CART. Now, I would have to go through all the training materials again, but I know that I made notes too that more is needed about CART. Maybe I need to be more specific 12 | Page

about what is needed. Not necessarily a videotape of it but, you know, more needs to be in those materials. I guess I will need to go through it again but I was a little dismayed when I saw future, future. And I really want it now. >>CHRIS RECINELLA: Marc, if I may? I just want to say, what's currently in the training, we have added a little bit to the CART section, and we have talked about when it's released to the client, when it's public record, how it's handled, once you have that document. We go over that it is this verbatim transcript. We have an area where we talk about some of the unique needs of the late deafened. If you have very specific comments, like this would be really helpful for your staff to know, dot dot dot that would be invaluable. Again, I need to emphasize, we don't know what we don't know. In writing this, we are learning a lot. And so if there's something where you say, okay, by and large, information might be useful later on, but there's something that is a linchpin to this being executed well, that's the kind of very precise information that would be very helpful to us in writing this curriculum. >>MARC DUBIN: I want to emphasize that I think a response that says, "noted for possible future supplement trainings" sounds fudgy to me. I really want to emphasize how important I think CART information is. You have a very large population of late deafened adults who don't know Sign Language, who don't use hearing aids, who have no way of being effectively communicated with in the absence of CART. It needs to be emphasized as Sign Language Interpreters is in my opinion. It should be in this. It shouldn't be supplemented possibly in the future. It should be here now. Here's my thinking. The number one injury for veterans coming back from wars is hearing loss. DCF, late deafened adults, has a whole division dealing with veterans programs. I rarely see any notice identifying that if you need CART, we will pay for CART. And in the absence of that notice, in the absence of emphasizing any training, there will continue to be a failure to provide CART. And I can't emphasize enough how much I think that's a violation of the ADA. And you are thinking taking out these violations, again and again and again, if anybody comes forward to say, I need the CART and it wasn't provided. And I think we should be stepping up and saying, CART is important, CART will be provided, and in your notices, as one of the auxiliary aids and services you offer, just like you could say, including, for example, Sign Language Interpreters, I urge you to say, including, for example, CART. And explain to your staff. And it's not just your statement it is all of your partners throughout the state who don't know a thing about CART, who have never been asked for CART. And it seems to me that this is one of those things that is a linchpin in my view. I think you have to step up and do it and do it right or you are going to find, particularly in the veterans programs that, they are going to continue to violate this. And I just can't emphasize it enough. >>MARSHA RYAN: I think we can strengthen that some. But I would actually like to say that we would like to have additionally -- we can strengthen the current training, but additionally, I would like to have other auxiliary aids, information out there that people can go back to and look at online, consistently, and if there's new devices, new information, then that can be added to that, so people can stay up to date with new technologies as well. >>RICK KOTTLER: Bob and then Susan. >>ROBERT FIFER: I want to second what Marc just said because the stats on returning veterans are pretty glum. And the majority of them who don't come back to jobs already are coming back to virtually nothing. The unemployment rate among returning veterans, especially those combined with disabilities, is very, very significant. The V.A. is falling short of being able to take care of all their needs, so if there's one population where you might see an increase in a particular group of individuals, it will probably be returning veterans who are qualified for Medicaid, unemployment, a lot of other benefits upon their return and discharge from the military. And this group may or may not be able to use hearing aids, they may or may not be able to use assistive listening devices, and if they come in for long-term services or 13 | Page

a significant level of services, then something like CART would be absolutely essential for them. Especially, especially if they have traumatic brain injury in combination with a hearing loss. >>Susan: Thank you. I read somewhere in the training manual -- I can't pinpoint it right this second -- but it did concern me that CART is public information, a public document. I'm a little bit concerned about that. I think as an individual, if I were to have any kind of confidentiality going on and I use CART, I would be concerned about the action being done correctly and any confidential stuff being released that shouldn't be released. Did I read that right, understand that correctly, that it is public record? >>RICK KOTTLER: There is one in there that I did read that that was the comment. >>CHRIS RECINELLA: That is correct. As our communications attorney, John Jackson, some of you I believe worked with him, what the public record policy is on CART transcripts, his response was that it is a public record unless confidentiality or redaction issues come up so this isn't just a transcript that we are going to be passing out with people's names and private information on it, where there's issues of confidentiality. This kind of speaks -- jumping a little ahead -- to Marc's comments about this document being the purpose being interred, as I pointes out. This policy doesn't supersede other policies, okay? So if there are program policies that talk about confidentiality, that talk about redaction of information, privileged information, anything like that, this does not supersede that. Okay? This works supplemental to that information. So if we have a CART at this meeting, my understanding is that that is public record. Okay? If we have a privileged conversation between the DCF employee and a client, there is other policies in place that are protecting that. >>RICK KOTTLER: Terri? >>TERRI SCHISLER: I just wanted to make a comment about CART, which is similar to our interpretations. The interpreters are not being videotaped so there is no record, whether there are any errors in what they interpreted. Same thing -- well, with CART, there is a permanent record of what has been done, but CART is unedited transcript, so there are occasionally some errors. There might be an error in the CART transcript that would affect your actions. And so, using CART, you should always remember that it's unedited, and there may be an error in there somewhere. It may be a simple error may lead to, oh, that's not right, something that couldn't possibly be, but you have to know that even with the best of the best, there could possibly be an error in CART transcripts, because it's unedited.

>>MARC DUBIN: That also brings to mind that when TTYs are used, some TTY machines have a transcript of what's being typed, and so I would also urge that both your legal counsel's office and your training to address what's done with those documents that are produced through TTY machines in terms of keeping those records separate in the case file of the individual, identifying whether it's a confidential or privileged communication. Because all of those issues are also going to take place with TTY communications, where they are making a printout. >>RICK KOTTLER: Okay. Let's just hold this, stop for a minute. We are right close to taking a break. So why don't we go ahead and do that. I think this is an important discussion. We may need to extend it past 11:00, if we have to go through it. Michelle, will it be all right with you if we have to push you to right after lunch for your discussion, then we can spend some time on this? Does anybody have a problem with that? Okay. Let's take a quick break and be back here at 10:30. >>(Recess taken at 10:17 a.m.) (correction Shana was discussing with Michelle, not with Shonna (way back up there.)

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>>RICK KOTTLER: We need to get started again. Okay we all set? Lois has a comment back on Page 4. >>LOIS MARONEY: This is Lois Maroney. I am looking at the bottom of Page 4. The comment that was made was, why would a person want to use CART instead of just writing a note? So in other words, if the DCF employee knows that the person can read English, why would you get CART in instead of just writing a note back and forth? The response doesn't really match what the point was, and so that's why I wanted to talk about it. The response, I think the person who is writing this is responding thinking we are talking about someone who is deaf and their English proficiency. But that is not what the point is. The point is, why would you write -- if you were working with me ten years ago, why would you write back and forth instead of having a full transcript? Okay? So that is what needs to be addressed are. >>CHRIS RECINELLA: That is correct. I was writing that comment, and that was me probably reading too quickly through that. It's an excellent comment. One of the things that we do address is that handwritten notes are only permissible when you are making an initial assessment he, you know, and someone walks in unexpectedly. You are trying to figure out what the best way to communicate with them is. Or an emergency situation where you've got to really get some kind of information, I need your name, something like that. One of the things we have added -- and we will get to this in a bit -- regarding the reading proficiency, some of the ASL syntax differences as an example, getting to why would we use CART for some of those longer handwritten notes for written communications, other than those two options, if there are points that need to be added again, specific examples, these are things that need to be addressed of why CART is so vital. This gets back to what Marc was saying, and some others, bringing this up earlier, those notes would be really helpful.

>>RICK KOTTLER: Okay. Any more on Page 5? Page 6? I have to say on Page 6, Terri, your comment on identification of the disability, was extremely articulate. I love it thank you very much. Anything on 6? Moving to 7. I have a question. Where we talk about the communication assessment form, did the interpreter services meet the expectations of the client? And the comment is, the staff asks the client directly. How does that happen? I mean, you are going to ask the same interpreter if they are doing a good job? That is a little confusing. I don't know that you could get a reasonable answer. I am open to suggestions.

>>CHRIS RECINELLA: I will ask Carolyn to address this in more detail than what we currently V. We have the communication feedback form. Now we are talking about an instance where someone may not be able to read has form and might have help with an interpreter using that form. And I don't know. I will be honest. So if we have either a good practice, you know, or a good policy that we have in place, and it looks like Michelle would like the microphone. >>MICHELLE RISKE-MORRIS: That was actually something that I added and it is actually for the client. They have to -- previously, communication assessment form was completed by the staff worker, not having the client participate in that completion of that form. The only thing that the client was involved in was the request for services form, where they indicated yes, I want services, this is what I want, or no, I do not want services. So we added to the actual communication assessment form where the client is actually a participant in that form and also signs off on the form. If they can read the provisions, it asks them was it effective, they can check the box, and then they also sign off on the form. But if there are other ways to 15 | Page

communicate with them if they are not able to review the form and then sign off on that, that would be helpful. But my goal in inserting that was, I felt that there was nothing -- besides the customer feedback form which they may or may not complete at the time that that individual is requesting services or receiving services from the DCF facility, that something be tracked to gather their input. So that's why it was inserted. >>RICK KOTTLER: Terri? Then Susan. No. Shana. >>SHANA WILLIAMS: As a psychologist this has been a nemesis throughout my career, to gather valid data without the confidentiality issues. What we tried to do in my practice was create a very simplistic, almost insulting, simplistic check-box form that has smiley faces showing different degrees of satisfaction. Very simple, very short, and they could just say interpreter good communication, interpreter smooth, interpreter skilled. Very, very simple, with smiling faces. I will be happy to share that form. You could change the verbiage on it. >>TERRI SCHISLER: I, again, came into this process late, so you all had conversations that I wasn't a participant in, so I have been trying to fill in some gaps here. I have some concerns or questions, I guess, about your evaluation of a person's communication, other than directly asking the person, which that would be great, you know, just to ask the person, what methods do you prefer? What will help you best? And let them tell you. I see in several of the documents where in your aid-essential communications that a survey interpreter is required and there is no discussion. A survey interpreter will be provided. And that provides that part, you know, that you all recognize a survey interpreter is necessary if it is aid-essential. But in other situations or where other services are needed, being able to ask whether the services were effective or being able to communicate what services do you need, when you don't have the auxiliary aid or service in place to ask the question, I'm not sure how you can get those answers. I am thrilled that you asked directly to the person, rather than having you all, DCF staff, make that determination without the person's input. That seems like -- I'm not sure how a layperson assesses communication needs when you have limited experience with a deaf person or the varieties of deaf people that are out there. So I have tried to figure out exactly what that means when you you are doing communications assessment, what questions do you ask, and who do you ask them of, to determine their communication needs. And the other thing similarly that I have noted is that you have some signage that is required to be placed out in a common place about requesting for interpreter or needing assistance, and the sign has like 20 different languages there, one of the signs, and very small type at the top in English it has a statement, but for a deaf person who sees that sign, they are not even going to look to find the English word on there. So I think that sign is not that friendly, and if you had something -- there are one or two different documents I saw -- there was one that you posted out in the lobby, can't remember what it was, saying an intercepter will be provided to you or auxiliary aid will be available for you on request, something to that sort. And those two documents I saw are not deaf-friendly at all because there are too many words on there. Even if there are 50 different languages, the English is in small type at the top and the person is not going to look at that to find the English to see what it says so providing that information to a deaf person may need a separate sign that's geared toward the Deaf and hard of hearing community. Again, that's in English language, going to be more reader friendly, but also have some visuals. An interpreter, some of the common symbols for TTY, video relay, those kinds of things. So assessing communications assessments has been kind of a ... >>MICHELLE RISKE-MORRIS: Could you give some examples of what maybe the sign should look like? Because they have two different signs. They have one for the language. That is what you are referring to. Then they have a different one that references for auxiliary aids and services, but even that being said, I think what you are saying is, even with that separate form, it's still too much wording. So if you could give 16 | Page

examples of what the signs should look like, that would be great. >>TERRI SCHISLER: Sure. >>RICK KOTTLER: Marc? >>MARC DUBIN: This question on the communication assessment form addresses whether the expectations of the client were met. I want to suggest it might be helpful to have the client as well as the DCF employee identify what those expectations are. And in that way, you can independently assess not whether they felt good about it or bad about it, but whether the expectations, in fact, were met. If somebody comes in and they expect a certain service from DCF, having either a checklist of what you can anticipate the expectations would be, so somebody comes in and they need food stamps, you may have expectations of how long it takes to get the food stamps, how long it takes to get served, how much money they get, whatever those traditional expectations that the DCF worker wants to fulfill, maybe a checklist. And maybe the client can also say, this expectation was or was not fulfilled. And that way, it's not as subjective, whether the person just feels like the expectations were met, but you can actually identify, maybe because of communication issues, which expectations can be enhanced, which were not met. And that might in the long run give you a better sense of where the effective communication breaks down. >>ROBERT FIFER: You are going to get your exercise today. A comment and a suggestion. The comment, be careful of abstract comments like "expectations" because you are going to encounter a wide variety of language abilities, educational levels, et cetera, among the deaf and hard-of-hearing community. There will be those who understand what this means, "Were your expectations met?" There are others who may not have a clue what this means. So that is my word of caution regarding the abstract comments like, "Were your expectations met?" Suggestion. It seems like at every meeting we have been at we have piled on you and said, you got to do this, this, this. This is a suggestion. Okay? This is not a "you gotta do this." It could be worthwhile in your county or regional offices to have a public forum every six months, or so forth, among the deaf or hard-of-hearing community, to come in and give you face-to-face feedback. We used to do this, back in my deaf services bureau days, periodically. The number one comment that we got was about interpreters; the clarity of the Sign Language that the individual was reading; or issues about confidentiality on the basis of an interpreter. And these are things that you may not be able to glean from a post-service questionnaire. That may come out more readily in a group forum. And you'll find basically two different populations with regard to willingness to give you feedback -- from the individual versus from the group. And that group forum can also be worthwhile to give you suggestions based upon "how am I doing? You don't ask questions quite like that, but to give you feedback on how you are doing in serving that population and then you can provide feedback to the main DCF office in Tally, Tallahassee, and adjust, modify, whatever, run it through the consultant, through the Office of Civil Rights, based upon actual feedback from the people that you are serving. >>RICK KOTTLER: Go ahead, Michelle. >>MICHELLE RISKE-MORRIS: Just so you know, we are actually doing that now but in terms of focus groups. We had one last week that I will discuss. We are not doing it every six months, but we are trying, and I am encouraging, after the feedback that we got from the first focus group, that at each area that they go out to monitor, each region or circuit within that region, that they conduct a focus group, and we contact the local Deaf Service Center when we go there to try to utilize their contacts so we can get the word out to as many people as possible so that we get individuals coming in. So we are doing that. 17 | Page

>>ROBERT FIFER: Good. >>RICK KOTTLER: Okay. Let's move on to Page 8. Terri? >>TERRI SCHISLER: The one comment that I have on this page refers to the how do you know if someone is certified, that comment. And the response was that the process was based upon local procedures, but what you need to provide in your training is that you can determine the qualifications of an interpreter by verifying it for yourself off of the R.I.D. Web site. So every agency should know, every office should know that. Any interpreter who walks in your office who says they are certified, if you go into the RID Web site and go into their interpreter database, if their name is not there, they are not certified. The database is accurate, but there may be a time lag, so if you find that their name is not there, you may ask them, were you recently certified? Because we didn't find you on the Web site. So there may be a month or two delay in getting onto the Web site and in having that information updated. And if you are using precertified interpreters who may have a QA level in the state of Florida, those are all available on the FRID Web site, and that is very current. We keep that up to date, within a few weeks. So if someone gets a QA level, their names are added there very quickly. >>RICK KOTTLER: Anyone else? Page 9. Page 10. >>MARC DUBIN: This might seem to be a minor point, but the Department of Justice address being wrong in the material, the response was that there's an accurate alternative address by the Office of Civil Rights. The reason I press this again and again is because many of your partners are Title III entities not Title II entities and Title III entities are covered in terms of complaints and enforcement by the civil rights division of the Justice Department, not by the Office of Civil Rights from the Department of Health and Human Services. DCF is going to be looked at as a Title II entity, and OCR is the enforcement agency, but many of your partners would be in violation of Title III if they don't provide effective communication and therefore the complaint could appropriately be sent to the civil rights division of the Department of Justice, which would then likely refer it over to OCR. But I am just of the view that you want to generate as much information as you you can from the field about what's going on. And you are not likely to run into any additional problems if the complaint goes to the Department of Justice. The problem is going to be if, for example, a domestic violence shelter is a private, nonprofit, then that would not appropriately go to OCR, except that it would be alleged at your ( ) because your partner is. I am suggesting that your address should not just be an alternative address but I recommend you putting the civil rights' division information in there as well as OCR's information.

>>RICK KOTTLER: Okay. Page 11.

>>RICK KOTTLER: Terri? >>TERRI SCHISLER: And just so everybody knows, you all put me on the agenda later this afternoon to talk about the aid-essential and non-aid-essential and use of certified interpreters so I am holding those comments -- (repeating) -- until later, unless you want me to go ahead and give them now. That was put on the agenda. I am already on the agenda. So I have some concerns about those. But specifically on Page 11, this is about getting a comparison of ASL to English. And what is also helpful when you show a sentence in ASL and English, that you also show, for example, Spanish, because not only is ASL different from English, but English is different from other spoken languages as well. So when you just show ASL compared to English, people may assume that ASL is a lower form or not a robust language, not as sophisticated or having the depth of knowledge or communication as other languages but when you show that ASL is a language like English and Spanish 18 | Page

and all of them have different vocabulary and different syntax, you have ASL being seen as equal to all other languages and not lower than. Because if you read ASL, if I were to write the signs in order and you read it, and then you say it out loud, then it sounds like broken English, like when you meet a person who may be from Mexico who has -- is not fluent in English, they sound illiterate because they're not using proper English. They are not illiterate; they just don't use English as their primary language. So we don't want ASL to appear to be a lower form of English or not a complete language, and along that line, ASL is a complete language, but some of the sign systems that you are referencing throughout the material are not languages, so any time you see PSE, Pidgin Signed English, or SEE, Signing Exact English, those are not languages. So some of those should not be -- either eliminate your questions or some of those answers, because some of those languages, Signed Exact English or PSE, are not languages. They are based on English order, not ASL grammar. So my reference is to add a comparison to Spanish as well. >>RICK KOTTLER: We should probably wait until after lunch -- (Yasmine is saying we should break.) >>RICK KOTTLER: Does anyone have a problem breaking for lunch at 11:30? All right. Moving on to Page 12. Page 13. Just for a second, I will go over where my problem was with that. Excuse me. And it ties into a lot that Terri wants to talk about this afternoon. But we have to give people enough guns to make a decision on whether something is aid essential or it's non-aid-essential. There's no way that we can give them a list of every aid essential situation, that's totally impossible. So if we explain to them that these are the criteria that I need to use, then at least they are think thing along those lines, and we know the importance of the conversation is part of it; time involved is part of it, complexity is part of it, but complexity is in most cases dealing with the subject matter. Then how many people are involved is a separate issue. If you are having a general discussion and Debbie can chime in on this, and you have six people having that whole discussion, and it may not be the most critical thing in the world, but in order for that person to participate, they're going to need an interpreter involved in the situation. So it doesn't have to be always complex to require a lot of people, so the two of them really need to be separate. And particularly I think in a DCF forum where you are having a general meeting with a family, and it may not be the most critical thing, the discussions that you are having, so it may not meet the criteria of complex and important. But to include that deaf individual by a number of people, it becomes a critical situation. Debbie, do you have anything that you can add to that? >>DEBBIE LAURICELLA: Now you guys have to understand me, oh good. The only thing I would add is that ASL does not have a written form. Because if we are comparing ASL to English and you are glossing ASL, there is no written form of ASL. It's a signed, visual language. So you need to keep that in mind. You know, everything that is spoken and written in ASL, there's not a way to write it. I'm sure that we can discuss that more later. I haven't had the opportunity to read this document in full like I all have, and in order to participate in the discussion I have to watch the interpreters so I can't read it right now. If I had had it before hand, that would be better, but I will definitely catch up with you all next month. >>RICK KOTTLER: The bottom line I think, concern of everybody in here, is aid-essential versus non-aid-essential. That is the one thing we see as being a problem somewhere. Michelle? >>MICHELLE RISKE-MORRIS: Yes. I was actually -- I didn't want to include -- I talked to ( ) more. Number of people involved. One of the things I found in the site visits is I don't want to say the number of people involved, giving the impression that if we have two, 19 | Page

just myself and a client, it may not be essential, because number of people involved kind of assumes that you are going to have more than two, otherwise why would you put the reference? One of the problems I have seen at the DCF facilities is that when an individual goes in to fill out an application and they are working with an individual in the lobby, one of the workers, that is an aid-essential communication. However, it's only those two individuals that are interacting, and the worker may go on their own perception of, well, I'm getting the information that I need, so everything's okay. And that is not -- >>RICK KOTTLER: You are not understanding what those four things are. Each on its own defines an aid-essential situation. So what you are saying, filling out the form, is its importance, so it already qualifies. They are not made to rule anything out, they are made to define it. So it has to match at least one of those four. >>Michelle. No, I agree with you. >>RICK KOTTLER: So by not matching all fore does not mean it is non-aid-essential. So. >>MICHELLE RISKE-MORRIS: Now I fully understand what you mean by that. So it is actually included in there, and then they will have to highlight that more. >>RICK KOTTLER: Marc? >>MARC DUBIN: Just briefly, what comes to mind for me, though, is if you have somebody who is using CART as opposed to a Sign Language Interpreter for effective communication, and you have a group of people, that's going to complicate the ability to have effective communication, because they are going to not necessarily be able to communicate in a large group. So maybe others are more articulate about that problem or familiar with CART, but my understanding is that with a larger group, CART can become less effective as a communication tool, if you have a larger group than a smaller group. So I just think it's important for your staff to think through how to train on that concern. >>TERRI SCHISLER: I didn't understand these comments earlier so I'm not sure what we are talking about, the four criteria. What are the four criteria we are using to determine aid-essential? >>RICK KOTTLER: Those are the ones that are defined by the Department of Justice and OCR -- importance of the conversation, the time involved, the depth of the conversation, what else? The number of people; -- go ahead. >>CHRIS RECINELLA: Here's the thing. The glossary definition has the importance, the complexity, and the length of the communication. Okay? That is the glossary definition in the agreement. However, those three things are only one item included on Pages 21 and 22 of the settlement agreement. Okay? They are item B. The type of auxiliary aid or service being requested, the individual's communication abilities, the individual's health, status, or changes to their health status, and the number of people involved in the communication are all other elements to be considered according to the settlement agreement. Those changes have been added to the instructor guide and participant guide. I'm modifying our glossary definition to include all of these elements. So there's three things -- length, complexity, and importance, and they're only together one unit of those five units. And again, that's Pages 21 and 22 of the settlement agreement. We will be sure to speak more to that this afternoon. >>RICK KOTTLER: The thing is, the Department of Justice uses number of people also in that list, and we wanted to expand it and to make clear where there's a difference. >>MARC DUBIN: Just two quick points. First, the information you just shared about the preference of the individual consumer, that really comes out of Title II's obligation to give primary consideration to the expressed preference of the individual who is deaf or hard of hearing as to what auxiliary aid or service they want. So that's why I think that's in there. 20 | Page

But one of the things that I used to use, it's not exactly in there, but it's a consequence of the definitions that we are using, and that is, the consequences of getting it wrong should be a factor. Now, you don't necessarily have to put it in there, it's not in the Celt settlement. But the reason I push that is, it define it is complexity. The more complex it is, the more risk there is that there will be consequences of getting it wrong. So D.O.J.'s technical assistance doesn't say that, but in my view that's really the end result, is if you got a failure of effective communication and there's a significant consequence, like a doctor doesn't prescribe something correctly or diagnosis something correctly as opposed to you got the wrong cheeseburger at Burger King, the consequences really flow from the nature of the complexity of the communication. So it may be helpful to educate those who are assessing what to provide, to think about it in terms of, if I give the wrong communication method here, what's going to happen? Are they going to have significant consequence for misunderstanding me? Or is it going to be pretty insignificant? >>RICK KOTTLER: Any comment? Okay. The only way we are going to get through this is to go through the pages that are left and look at the comments that you received that you disagree with. Okay? Let's deal with those specifically. And then if we have a few minutes, we will open it up for general comments. Now, Judy's did get N. You did include Judy's comments. Okay. >>CHRIS RECINELLA: Judy's comments were added. There were also a few from the CART, from the meeting last month after we left, that last hour of comments, that were added. Those are all at the end. They have all been appended.

>>SHANA WILLIAMS: I have a question on Page 13, the definition of a companion. You have it as someone who is deaf or hard of hearing and speaks on behalf of the customer. My understanding -- I think Marc might be able to clear this up -- is that a companion may be a hearing spouse to a deaf person, not necessarily a deaf individual -- I'm sorry; they would be the deaf spouse of the patient who is hearing. >>ROBERT FIFER: Mm-hmm. >>SHANA WILLIAMS: Did I say that right? Okay. >>CHRIS RECINELLA: I understand what you are saying. So the customer, as it is termed in this context, may or may not be deaf or hard of hearing, but the person speaking on their behalf is deaf or hard of hearing. >>RICK KOTTLER: I don't know that they need to be speaking on their behalf. They are associated with them, they are with them, they are going with them to the meetings. They are a child, they are a parent, they are a husband or wife. A friend, you know? I mean, someone involved in the situation with them. >>ROBERT FIFER: Mm-hmm. >>RICK KOTTLER: Bob? >>ROBERT FIFER: From my setting, a companion could be someone who is hearing, when, in fact, the individual of record is deaf or hard of hearing. Or, the companion can be someone who is Deaf and hard of hearing, where the individual of record is hearing. It may be the same-age companion, may be a spouse, relative, a child, but don't restrict the definition to someone who is Deaf and hard of hearing necessarily. It's someone who is involved, directly involved, and needs to participate in the communication. >>MICHELLE RISKE-MORRIS: Unfortunately, we have to go by the definition in the settlement agreement unless they modify it, and the settlement agreement defines companion as "shall mean any individual who is deaf or hard of hearing and is one of the following," and they list the person who a customer indicates should communicate with DCF personnel about the customer, such as a person who participates in the treatment decision, a person who communicates the role in a customer's needs, history 21 | Page

or symptoms to DCF personnel, or a person who helps the personnel to act on the instructions or information provided by the DCF personnel; (B), a person legally authorized to make healthcare or legal decisions on behalf of the customer; or (C), such other person with whom the DCF personnel would ordinarily and readily communicate about the customer. Those A, B, C are pretty expansive and cover a wide range. However, there is the criteria that the individual is deaf or hard of hearing. I mean, that would be something that we would have to take back to OCR. >>SHANA WILLIAMS: Actually I think there is some new ADA language that talks about companions and their rights in the treatment facility, in the treatment scenario. And I do agree that those definitions are expansive. So what I'm saying is that the companion is a spouse, and they are going to help the patient receive that treatment and take their meds properly or go through a foster process or whatever. That spouse is their support system. So support system would be somebody that would be entitled to participate in that group meeting and therefore be able to receive those accommodations. So your definitions, I still argue, needs to be revisited. >>ROBERT FIFER: It might be worthwhile for some more discussion, because, you know, the main point of this exercise is that somebody who is seeking services from DCF needs accommodations of some sort, whether it's Sign Language, assistive technology, whatever. And that may be the client or it may be the companion. But, you know, when we talk about a companion, all of a sudden the diad becomes a triad, and the same principles will apply. It is important to consider the companion if that person is deaf or hard of hearing but not necessarily just limit it to that, because that has the potential in a legal definition or a federal definition of excluding some people who are there to assist the client when the client may be deaf or hard of hearing. Am I making sense? >>MICHELLE RISKE-MORRIS: I'm sorry, if the client is deaf or hard of hearing, those services should be in place. >>ROBERT FIFER: Right, but ... >>RICK KOTTLER: Let me ask you to hold this thought. Let's -- I mean, this is a discussion that's going to take a while. If we were to put that on the agenda for the next meeting, and go through this, and 'pull out the new ADA, and see if there is a reason to go back to OCR and ask them to amend and change the thing, I think that's a whole discussion that we probably need to have. >>ROBERT FIFER: One quick follow-up. It is possible that the individual who is deaf or hard of hearing may have language issues that would compromise the effectiveness of communication. In this instance, the companion may be also someone who is deaf or hard of hearing or may have hearing loss and communicates orally, or may have reasonably normal hearing and communicates orally, and so, to restrict the companion in this scenario just as someone who is deaf or hard of hearing may be a little bit overrestrictive or some of the scenarios that you may encounter. >>RICK KOTTLER: Okay. Is that all right if we put 'it on the next agenda? We will get into this. Something new along that? >>MARC DUBIN: One last thing on that. I would also ask that you check with OCR about how they feel with respect to the changes to the Department of Justice Title II regulations. There is likely to be a conflict between what they require of DCF in the settlement agreement and what the Department of Justice new regulations mandate as a condition of compliance with the ADA going forward. And so O.C.R. I think might be well advised to give guidance to us about where there is an additional obligation. Let's say they clarify it in the Title II regulations but their settlement agreement doesn't have that clarification. It would be helpful if O.C.R. could tell us what their view of that change is. My view is, you are always OCR-obligated to comply with the current law. So even though you would not be in violation of the settlement agreement, you would be 22 | Page

in violation of the current regulations so that's not a good idea either, but I would like to ask if they could go through the new regulations and give us guidance as to whether they seek a conflict, starting with modifications to the settlement agreement, has that they need to consider in light of the Department of Justice issuing new regulations after the entry of this settlement agreement. >>RICK KOTTLER: Okay. Any more discussion about responses? Okay. Since we have a little less than 15 minutes, how about general comments about the training program, where they're at, anything that you'd like to bring up? Terri? >>TERRI SCHISLER: I just want to know if after lunch we will be reviewing the documents that were e-mailed to us on Friday? Are we going through those today? Or is that inclusive in our conversation here? >>MARSHA RYAN: Only if you want to look at any of those documents. Or make comment to them. I am open. What we did was, we made changes based on all of your comments here and our responses to the last time you saw or last time there was the instructor guide and participant guide and the demonstration. We used that as the basis for making the instructor guide and participant guide in the development of materials for the direct services, also included in there. And, in addition, we added the online training as a word document for you to see what we also had put in there. Those are different, and you may not have seen the latest copies of those. But it's all based on the information that we've received from you from the SPOC training that we have gone through very detailed. >>TERRI SCHISLER: My question is because I wasn't here for the previous meetings so from the last meeting which was when I first started and in the last four weeks I have reviewed the whole manual that you you gave us last week, so I do have some additional comments to some of that material, and there are some specific comments to some scripting that's in there, scripting of the videotape, and so if you want, I can just e-mail that to you, or would you like me to -- >>MARSHA RYAN: That would be best for us to take specific recommendations and language, if you've got specific language you'd like to see for comments. That would help us. Not just saying it needs to be expanded but tell us how. Very helpful. >>TERRI SCHISLER: My concern was in the scripts, there was online training script that you were using and definitions, comparisons of ASL and English and grammatical corrections there. There was one example that you gave that said ASL has 4,000 signs while English has 400,000 words and that's not accurate, and so I had several changes to that particular script. That I would like to introduce. >>MARSHA RYAN: I would be happy to have that. >>TERRI SCHISLER: Some other comments to this particular material we have gone over today, but I wasn't sure that we were going to go -- since you I wasn't here when you went over those I wasn't aware so I will send those to you. >>MARSHA RYAN: Thanks. >>RICK KOTTLER: That was if plan. We had already been through the documents so we were going to go through the Excel spreadsheet to finalize things. >>ROBERT FIFER: Just a general comment. Since I was not here the last two meetings I beg your indulgence on this general comment. I offer this more as a reminder than anything else. When the training occurs, the goal of competency is not to teach the DCF staff to pose the first question, "How do you classify yourself?" You know, how do you classify yourself? Who are you? Or, you know, I'm a rabble-rouser, and that's how I classify myself. But rather, say, you know, what do you you need for us to be able to serve you? And many times they will know and they will be able to tell you, even before they come in. Sometimes they will say, I don't really know. And the competency level on the training should have the goal of being sufficient 23 | Page

that when they say I don't know, then you start down the checklist and say, would it be helpful if we provided this for you? Would it be helpful if we provided this for you? But, you know, the golden exercise is, how can we help you? How can we communicate with you effectively? Not so much how are you classified. That information is necessary as background, foundation information, so they are aware of some of the land mines that they might step on. They have an understanding of these groups that we're talking about. But that's not the goal of the exercise, to classify. It's what do you need from us for us to be able to help you? And I offer that just as a general reminder.

>>RICK KOTTLER: Any other comments? Okay. Well, then, let's close the meeting and we will start back at 12:30. >>(Lunch recess was taken at 11:22 a.m..) >>RICK KOTTLER: . Okay, let's get started. Michelle? This is all you. >>MICHELLE RISKE-MORRIS: Good afternoon. Is that better? Yeah! Okay. What I'm going to talk a little bit about this afternoon is the monitoring plan that we sent to you, I think the beginning -- June 1; and then subsequently also the site visits that we just started to do, keeping in mind that the site visits, one of the purposes of these initial site visits, in addition to ensuring compliance, is to also kind of pilot-test the monitoring and see how the monitoring plan is implemented and all the information from tapping into other sources -- although I think we are causing a stir, so I think we are doing something right. First off, with the monitoring plan, if you haven't had a chance to review it, I'm going to give you a little bit of summary of how we propose to do the monitoring. The monitoring that I will be doing is in the next 15 months, maybe, I will be doing monitoring as an independent consultant. DCF representatives, especially Carolyn, and the Office of Civil Rights coordinators in each of the regions will also be coming out to the site visits. We'll be doing site visits in that 15-month period. But once that's completed, DCF will then undertake to do site visits in a similar fashion, continuously, the goal of which is to visit every single DCF facility as well as contract provider within a specified time frame. So the site visits will be something that is an ongoing function that DCF Office of Civil Rights will have and it will be a monitoring of DCF facilities as well as contract providers. With the site visits we are doing, the first thing we are scheduling is what I refer to as entrance conferences. The entrance conference with a DCF facilitator, contract provider, upper level management staff. I think it is important to meet with them in terms of how are they implementing the settlement agreement, how are they ensuring that their staff are compliant with the law, and to find out from upper level how they feel they are doing. Now, granted, most of them will tell you that they have no problem, everything is going fine. We are implementing it, the whole staff know what they're doing, you know. But then it's nice to have that kind of conversation, and I hate to say this, at the door where they are saying it's going great, and then you follow through with the other interviews, and then you find out it's not so great, so it's a way to go back and say, well, you said it was perfect, but guess what? You need some work. So we do need an entrance conference where we go through discussion questions, and we leave it to them as to what their process is, what their policy is, how they are enforcing the terms of the settlement agreement and compliance with the law. With contract providers, we also impress upon them what are they doing to train their staff. Because under the settlement agreement, DCF has a responsibility to train their staff. But they provide the information to the contract providers who in turn have the responsibility to train their staff. Part of our monitoring is to also find out how they're training, get copies of their 24 | Page

training material and to verify all staff have been trained so we are doing that as well. So it's a check. I don't think they were quite ready for when we came in and said, give us your attendance sheets, we want all of them. And one of them said, they need to be employee files. We said well you can make combs of them and send them to us. We do that as well with the contract providers. In addition, usually the director, the supervisors, then we meet with the SPOCs for each of the service facilities. And, one thing that's nice is that even though the management staff want the SPOCs to be in on their meeting, we don't want that, so we separate them. Because if you hold a management meeting and you allow the SPOC to participate, usually management just defers to the SPOC. Well, they know how to process is, they'll handle it. So we separate those out. We meet with the SPOCs and the interviews usually last an hour, I think. And we do find out from them what resources they're utilizing. I impress upon them and I communicated this to Marsha, I said, a lot, that they need to impress upon the SPOCs they have a responsibility to monitor their program or their region or their agency if they are a contract provider, because they're the ones that are there on a day-to-day basis. What are they doing? Are they reviewing the communication assessment forms that are completed? Are they reviewing the case notes to review if an interpreter was requested and was present? And every time the agency had contacted that individual for appointments, that an interpreter was provided? So we work with the SPOCs. One thing that I have found in monitoring agencies' compliance with settlement agreements that is the first round of site visits when you are going out and visiting every facility or every contract provider or program office, the first round, a lot of it is, yes, ensuring that they are complying and what they're doing, but it's also an educational experience for the agencies. Because you are asking them direct questions about what are you doing, and how are you complying, and you do find, unfortunately -- and we did find, where certain areas of misunderstanding, they weren't doing things correctly. There will be a lot of corrective action plans that are recommended. And will be put in place because of that. However, it is a learning process. So once we meet with the SPOCs, then we interview line staff. We usually try -- occasionally we will interview supervisors but primarily our goal is to interview direct service personnel. And I will tell you that if the agencies are great about saying, oh, yeah, we have a lives people for you to interview. And we say, okay, that's okay, we just want a list of staff. And we randomly pick who we want to interview so we don't allow them to pick who to interview. We do tell you if they have individuals that have completed assessment forms and have worked with deaf or hard-of-hearing clients, we will interview them, you know. So if they are available, we will interview them as well. But we do interview staff. And you start to see, you know, the disconnect. And we hopefully see that the training that you do for the direct service personnel that you are going to see, they understand what their responsibility and their roles are. On top of interviewing staff, we also review their case files, so we do go through all the cases where communication assessment was completed, even if a waiver was signed. We still review all of those files. And we get information from those, because, again, besides the SPOC verifying that the services were received, we're also looking in the file to verify. And we have had technical assistance provided to many providers to say, you may be completing the form and saying you are provided an interpreter, but I don't see it in the file where you provided an interpreter. Show me where you provided it. Give us copy of the invoices if that is how you keep track. If an individual stated that they did not have services and we did see a lot of that. There were a lot of waivers signed where an individual said, no, just keep it out of it. Where is that document? Did you offer them? What are the available resources that have you? So we do look at the case files on top of that.

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Next thing that we do is, when we're going out to a site visit, we will send letters to all individuals who have completed or been involved with those communication assessment forms, whether they are a client, customer, or companion. They will all receive a letter inviting them to meet with us. And we really want to talk to them about their interactions with the DCF facility or the contract provider. They can either he speak with us over the phone, if they want, if they don't have a means to get to the facility. And we did have that occasionally where we had clients who would call up and say, I will speak with you on the phone at this time, but I don't have transportation to get to the facility. And so we will either speak with them on the phone, or if they come in, we will speak with them and ensure that we have whatever means they need to communicate with us, that we provide that on that day. We schedule them usually on one day, we will have a CART provider there, interpreters provided, so that we do have all that readily available. In addition to the interview, we also have been working with the local deaf service center. We had our first focus group. Fortunately Shana was great about organizing that. Focus groups were not anticipated in the settlement agreement but I have had focus groups before so I suggested that and DCF was very willing and accommodating to have a focus group. After the focus group we did last week, we are now kind of putting that in as a more effective means of really reaching out to the community and getting their thoughts and perspectives. I will tell you that the first focus group -- I have probably done about 60 focus groups in the last five years. It's the first focus group I have done where I did not have to ask one question. Usually I have set questions that I ask to guide the participants, to try to get some information out from them. I did not have to ask one question. No sooner had we introduced ourselves, the hands were up. I mean, and we had people out in the hallways that were trying to get in. And this focus group, we are going to change the format next time and do it at a public library, or conference room to maximize the space available. I mean, these individuals, the transcript, if you have a chance to read that, it was very informative. Unfortunately, in some respects, it was disheartening, because we went to facilities the day before or that day, and they said, oh, we have no problems, we are doing great. We're providing them service, no complaints, no nothing. Then you meet with individuals who had visited those same exact facilities and they say that is not what is occurring. So we learned a lot from the focus group and from the interviews, because you really need to tap into those compliance and find out how it's going and not just rely on perceptions of the staff. Any questions about the monitoring plan? >>VALERIE STAFFORD-MALIS: I got the impression from something that I read that the contracted service providers could opt to use the DCF training. Right? >>MICHELLE RISKE-MORRIS: Mm-hmm. >>VALERIE STAFFORD-MALIS: So they don't have to develop it from scratch themselves. >>MICHELLE RISKE-MORRIS: That is correct, they can use them. DCF will provide that to them. However, not all contract providers will do that. So we are verifying from them, what are your training materials? And if they use the DCF, have you Mott modified it? Because you want to see what they are training their staff on and ensuring that especially staff that have direct service contact with clients, that they receive a more in-depth training than like the online training that DCF does for all staff. So you have to be able to monitor that to see what they're doing. More than likely -- and I have seen this done before in other areas where I have monitored -- usually the contract providers will adopt word for word the state, like a DCF training manual. They usually do adopt it. But some contract providers, depending on if they are owned by a large corporate entity that has a quality assurance program, their own training program, they may actually change it somewhat. 26 | Page

>>VALERIE STAFFORD-MALIS: Just a quick question to piggy-back onto that, is this training now universally available? Because I have a group of contract providers down in Manatee County that are keenly interested, and I have been kind of doing home grown training for them but if they could get the DCF training, I think they would be better served. >>I know it is not available now because they haven't finalized it yet. >>MARSHA RYAN: We will have it available and online out on the Internet as soon as we get an agreement that it has been approved by the IC and the secretary of the department. That minute, we will go out there and work to provide it out there online. All of it. All of the training, the whole package. >>MICHELLE RISKE-MORRIS: And work with -- HHS has to approve it too. So ... >>RICK KOTTLER: Just a point of clarification. I have seen a lot in the plan, this is going to be two years, this is going to be three years we are going to do this. So this is going to run past the end, so this is something that is going to be continuing on with DCF. >>CAROLYN DUDLEY: Yes. We currently monitor all of our providers and our DCF yearly, or once every three years. But this is going to be a specific monitoring relating to Title II. So it will be ongoing. >>SUSAN HERRING: This is Susan. Let's see. I think I had forgotten. Oh. Michelle, did I understand you correctly that you encouraged us -- did we have time to look at the CART, the focus group that you referred to? If I did understand that, I would be very interested in doing that. I was wondering if a link could be e-mailed to me to get to it.

>>Merlin: I have just received the CART from the focus group and it has not been posted yet but we will get that out along with other documents. >>SHANA WILLIAMS: So the focus group just says participant and speaker? It doesn't -- >>No names. >>SHANA WILLIAMS: Thank you. >>MARC DUBIN: Thank you very much. Is everyone able to hear me? Okay. I just have three areas of questions if I may. You said there were a number of waivers. I was wondering if you could share with us how customers communicated after they waived the Sign Language Interpreter. Then I have two other questions. >>MICHELLE RISKE-MORRIS: This is Michelle. Real quickly I wanted to address the previous comment about the confidentiality. During the focus groups we don't ask anybody for their name. We don't ask anybody to identify themselves when they are speaking. It is simply, this gentleman, this young lady. However, we did, after the focus group -- I put DCF out there and I said, if anybody has specific issues they would like to address to DCF and would like to give their information after the focus group is completed, then they could sit down with DCF, Carolyn, and then Caroline, who is the civil rights coordinator for that area. Actually ten individuals came up and provided their information. So they are following up on that. Now, it may not always be a DCF facility, but at least they provided their information so we could follow up with them with contact information. So I just wanted to point that out. Secondly, regarding the waivers, we are just now starting to review the case files, but before I went to a site visit last Friday, I am still trying to -- I am getting all this information -- I actually had to mail my stuff home in a box because I couldn't take it all home on the plane -- to go through it. But I looked through all of the waivers. In almost all cases it was individuals who were hard of hearing that had hearing aids and they said, just speak loudly. 27 | Page

I even saw in some of the case files where the worker said, but we have additional ALDs we could use, we have a Pocketalker, for example that, can amplify the sound. Are you interested? And they still said no. Unfortunately, I still think you are going to see some of that where they will still want to talk loudly. Part of that is adult protective investigations may want to have nothing to do with DCF. And the more limited contact they have -- and they had other individuals who because of other issues they weren't able to communicate. They may have had psychological problems. There were clients that, for example, they couldn't interview because they had dementia. They were hiding under the covers and they couldn't communicate at all. There were other individuals who were intoxicated. So even though they went back later, they couldn't communicate with the individuals. But I'm now just starting to go through all the various waivers to see. But what I do see a lot is they speak loudly. Ment -- they say to speak loudly. I do have concerns which I have been working with Carolyn on, is we went to some of the Access facilities. There, I'm not sure that waiver forms and assessments were actually signed, because I think the workers' perception is is if somebody is walking through the door to fill out an application and they are giving them basic assistance in filling out the application by just writing information back and forth or filling out the application on Thai behalf, that that's fine. But it's not. And so, we're dealing with it now in part of the training to reinforce that it's not based on the worker's perception, it's based on the client's perception, and to really get that out there. It's frustrating to individuals to simply have to write information back and forth, even if it's just filling out an application. That's an aid-essential communication. You have to provide appropriate means to effectively communicate with those clients and companions. So we are working towards that because we had uncovered that as a problem. So the focus group was very enlightening to us because we were out in the service facilities and they are telling us -- you know, we would ask them, how do you gauge whether or not communication is effective? And I had two advise, two SPOC, at two different Access facilities, say, well, we see those with the completed applications and they are getting their benefits. So they came in for food stamps, they are getting their benefits to them, everything is going great. But when you speak with the client, they are still frustrated because in many cases they may be getting that one service, so maybe they are getting food stamps, but they still don't understand the process. They still don't understand what's going on. Somebody may have filled out the application, but they don't understand it. Or, they weren't adequately informed that if you get cash assistance, now you have to file and you have to get a child support order. So all of a sudden, they are getting notices from child support, they have to go and comply with that to ensure a child support order. They had no idea. They didn't know that that was something that it's tied to that. So there's a lot of education work, and I think the training will help do that. I will tell you one positive aspect is that Leland King, who was at the SPOC training that was provided here in April, his program office -- he went out, after the training he received here, and he trained his staff, and we interviewed his staff. Again, we did it by random. He had a list of names for us to review. We said, no, we are going to interview who we want. And we pulled people and interviewed them. And I will tell you, they were much better in terms of their understanding of the rule and their responsibility. (Marsha cheers.) >>MICHELLE RISKE-MORRIS: So you will see when we go out and do more and more site visits that you will start to see a difference and that staff will better 28 | Page

understand how their role in the settlement agreement and the compliance with the law and what they should be doing. So I will say that that was one positive aspect. >>MARC DUBIN: Just two very quick follow-up questions. I'd be very much interested in the waivers of CART and the waivers of Sign Language Interpreters, let us know what that process is, and what they are using to communicate in the event there's such a waiver. The focus groups, the only comment I have on that really was, I would like to know what is used to communicate with the focus groups, and what is the announcement or notice to the public about the availability of CART and Sign Language and other services to the public so that there's effective communication at those focus groups meetings. >>MICHELLE RISKE-MORRIS: Real quick about the waivers and we will answer about the focus groups. With the waivers, in most cases what I am seeing is that the person actually writes on the form, just write notes back and forth. I have not seen any requests for CART. Again, we are just starting the site visits. This is one small area, not the state of Florida. I will be able to provide more information on what has been requested when I do the compliance report which is due in August. So I am getting information from all of the DCF areas, their monthly summary reports, which I've already gotten up through December. But I'm getting the communication assessment and other forms as well. So I have asked those. And I will receive from January of this year up through June of this year all of the monthly summary reports, which are based on the old reporting forms, but I'm getting those as well as the communication assessments and I'm going through all of those, so I will be able to provide you more information in August about what has been requested, what is being waived, so I can -- I can't do that now, but I will get that information to you. >>MARC DUBIN: Well, what I just wanted to express was, my concern is that if DCF doesn't affirmatively tell people CART is available, they are not going to request it, and there will be a waiver of it. The notices and even the discussions should affirmatively let people know for late-deafened consumers that that is an available option for them. Otherwise, I don't know that you will get a true picture of what is really happening down there. >>MICHELLE RISKE-MORRIS: And we are working with the training as well as when you go out to educate SPOCs, to let them know that if individuals are wavering services make sure you first let them know what is available first. Don't just say, no, I don't need anything, and write that down. First if they say I don't need anything, say but do you understand we have these available services, are you interested? And then if they waif, waive, make document that. So you tell them of all available services and the person still does not want those. >>MARC DUBIN: Do they specifically document that they offered CART and it was denied, or you offered a bunch of auxiliary aids and they denied them all. I would like to see if there is a way of documenting the offering of CART and the waiver of CART so we know what the true record is for late-deafened consumers. >>MICHELLE RISKE-MORRIS: On the forms, which we are trying to make as simplistic as possible, it says what services would you like? So we list that. I think -- I know, for example, there are items that are listed, like examples that are listed. >>MARC DUBIN: I don't want to belabor it, but my point is, if the DCF worker simply gives them a list and they check off stuff, they might miss the option of CART. What I am suggesting is an affirmative effort on the part of DCF and its partner agencies to affirmatively offer CART and have it waived. >>MICHELLE RISKE-MORRIS: It is one of the things that they do offer to say, these are services that we have available. It is on the communication assessment form. >>MARC DUBIN: Do they highlight it or just list it? What I'm asking is, it would be at least for the time being helpful to really see what the universe of requests are if they 29 | Page

highlight it and specifically say, I mention CART and they said they didn't want it. >>MICHELLE RISKE-MORRIS: Okay. Well, we can ask that they do that, but then, other individuals are going to say, well, you need to do that for every auxiliary aid, why are you doing it only for CART and not for anything else? So it may be where they are giving them a laundry list. Now, on the request for services, we are changing that name. Don't refer to it as waiver, because we had issues with that. So the form that they sign is not to be considered a waiver form any more. It is the request for services form. Because we found miscommunication where staff were thinking that if the person filled out the waiver form, they didn't have to do anything else. So we're now calling the request for services. CART is specifically listed as a option that they can check if they do want. >>MARC DUBIN: Okay. Again, I don't think that's what I am -- I don't know how other people feel but that does not meet what I am requesting. What I am requesting is something more than a checklist. I am requesting an affirmative decision on the part of the DCF worker to discuss CART and have it waived. I don't think it means they have to have a discussion on anything else, but CART is such a significant method of communication for late-deafened individuals that I think it should be discussed independently of all the others. >>VALERIE STAFFORD-MALIS: I was thinking about some of the wording that the Council uses on its meeting notices, when we have the quarterly meetings. We publicly advertise that we will have CART and also have Sign Language interpretation as well as assistive devices and then we have a clause in that meeting notice where we ask people to notify the council's administrative assistant if they require other assistance. I'm sorry that I don't have one of those with me but what I do have with me is one of the teleconference meeting notices where we are advertising the fact that we are going to have CART and we actually publish the StreamText link as well as the administrative assistance contact information for further assistance. So I am going to give this to y'all, and then when I get home, I can send the other, or you can go on the Council's Web site and just look at upcoming meetings and look for the May quarterly meeting, and you will see the type of verbiage that we use, and we put that in all of our meeting notices so that people know, and they know how to access it and who to get in touch with. I will give this to you. >>MICHELLE RISKE-MORRIS: Thank you. >>ROBERT FIFER: Michelle, you just touched on something in your report that we haven't touched on before. If someone has hearing loss and they have hearing aids, it is not at all surprising that they do not accept the offer of a Pocketalker or anything else. In their mind, they have what they need. But what really struck a chord is when you say that on the form, the individual said, "Just talk louder." What that usually means is that the environment itself is not conducive for communication to someone who is using a hearing aid. Multiple conversations, a lot of background noise, for example, cause adverse effects for someone using a hearing aid to be able to understand communication effectively, just again on the type and degree of hearing loss. In that instance, it may be necessary for the DCF worker to think about trying to find a little quieter place, a little more environmental control to be able to sit down and communicate effectively. Because the offer of any assistive technology will probably be turned down. But at the same time, if the environment is not at all conducive to verbal interchange between the DCF employee and the client, then that can cause a problem that could be on the magnitude of other things we have. So this is one element of professional judgment that could be very important to recognize when there are difficulties with communication, and it's also very simple to resolve. >>MICHELLE RISKE-MORRIS: Thank you. I will tell you we can put that in. That is a good suggestion. Many things I reviewed were with Adult Protective Services 30 | Page

where they went out to the homes. I don't know if the individuals would be willing to go to a different area, but they can request that. >>ROBERT FIFER: No. If it was in the home and the environment itself was reasonably controlled, TV turned off, things look that, then they won't be playing games with you. They will be brutally honest. But if it's in the DCF office where there can be a lot of activity, that is another situation. >>MICHELLE RISKE-MORRIS: Yeah. The ones that I was referring to that I looked through, those were all in-the-home investigations. >>ROBERT FIFER: Gotcha. >>MICHELLE RISKE-MORRIS: I still have to go through the ones like at the DCF offices to see those indications and if there were waivers, what were the reasons for the waivers and what were they looking at. >>ROBERT FIFER: Right. >>SHANA WILLIAMS: I just wanted to give Carolyn a little feedback and it pertains to Marc's question. We found when we were advertising the focus group that the flyer was more effective than the letter. So we sent out the flyer to everybody, and the clients at the front window, we were handing them out. The clients at the deaf service centers are probably your best points. Selling PockeTalkers, Ativas, et cetera. The one thing we missed is some of that verbiage that Valerie has that would be effective and also at the bottom, "If you need additional accessibility." For example, we had a Spanish-speaking parent and we didn't have a translator for her. They need to contact us for that, because there was only one; but if they had contacted us I am sure you would have provided that. >>RICK KOTTLER: One comment on CART, and it's an inherent problem with CART. A lot of the population doesn't know what it is. And we have had this discussion. And I don't know -- I will leave this up to the group to discuss -- I don't know that it is your job or DCF's job to educate the public when it comes to an auxiliary aid. Again, you can tell them, this is what CART is. It is basically real-time captioning. But to go into gory details? I don't think that's your job. A deaf individual walks in, knows what an interpret is, a signer is. I think that some of the own us has to be put back on the clients to say, I think you need to know what this stiffs. (Onus) I believe the hard-of-hearing clients are probably going to turn you down nine out of ten times. They don't like to admit they have a hearing loss, let alone want any accommodation for it. So that's not a big surprise. It would be a big surprise if they do want something. But the CART thing? I'm not sure how we address that in our own world. You know, I had this discussion here that one of my board members, she's got a Ph.D., and bilateral 'hearing loss, and did not know about CART. So, you know, it's not the that common yet. It's gradually going to go on, I think, but for right now, you are not going to see a lot of requests for it. CINDY SIMON: I sat on a board meeting of audiology and one person sitting there knew what it was. So the professionals have a long way to go as well. What I was going to say, an easy thing to offer, there's a big push through the Hearing Loss Association of America to loop America. This is very common in Europe, and anyone with a behind the ear hearing aid is going to have a T-coil most likely. I mentioned this last month. So to have at least one room at every meeting that's looped, where they can go into that room and have the option without taking something, or just switching to telecoil, might be a nice and effective thing to do. >>SHANA WILLIAMS: I just want to give Carolyn and Michelle a kudo here. In the area that they did the focus group, they had -- we had it looped. They had two interpreters. They had it CARTed. They did really an extraordinary job. And it was definitely a relationship with the staff at the center, to make those things happen. What they could have done is just get the notice out a little bit quicker and add that line that if you need something that we are not giving, to notify us. I think that was a good experience for them to know what was needed, going 31 | Page

forward. And to loop a library room would be a little different. >>TERRI SCHISLER: Re the CART discussion, I agree it's not widely known, but it's also, even for people who know about CART and have requested it, they typically get turned down because it's just as expensive -- I'm not even sure -- may be more expensive than providing an interpreter service. So when CART is requested, lots of times they are turned down, or it is for a group -- (Pause for teleconference call operator). >>TERRI SCHISLER: -- so providing CART for an individual is unique, and when that is offered that way, that is amazing services. The other thing I would like to ask is, when you are having these focus group discussions, I don't know if your goal is to target that specific area or just to target, you know, general concerns that may be from a little wider area, but if you would advertise it to some advocacy agencies and they could assist you in passing that information out, I think you would start to see it -- you know, you had a good response from this one, but the wider you advertise, the more likely you are to get some good feedback. >>MICHELLE RISKE-MORRIS: Yes, I agree, and we are going to try to do that each time we go out. Again, we are working on the monitoring plan. We have all these time frames of deadlines due, 4/28, 5/28. This contract is keeping me busy. But we're trying to get those notices out. And then it will be a constant process of improving, and we were just extremely pleased with the turnout that we received from the first one and it makes us want to continue to do them again and do that for each site that we go out to. And the notices will get better, the flyers will get better, and trying to work with the advocacy organizations. Because it's not a benefit if nobody shows up. So it is to the benefit to have the advertising so that we have these individuals coming, because they have a lot of information to tell us. And as I was saying before, as a researcher, when you are -- one of the things that I like to do is, although I am an attorney and I look at an agreement and I look at what does it require and what are you doing, I also have a research background. What I try to do is, whenever I go in and I monitor and look at what's effective, I try to gather measures from various points to say, if we look at it together, are we measuring what we should be measure something in this case, effective communication with individuals who are Deaf and hard of hearing that utilize the services of the DCF facilities. Many times, you will see in monitoring where they simply talk to staff, they review case files, and they may talk to management, and that's about it. So it's important to try to have other vehicles and other ways to get at that, which I think in this case, I am pleased to say that in terms of this particular settlement agreement, that there are other conduits to get at those resource. The focus groups are one. Interviews with clients, because some clients do want to give interviews. We have interviews scheduled tomorrow where individuals do want to be interviewed, and so I think that's great, because they'll have important information, specifically about their case. We also have the advocacy surveys. So we are trying to get as much information as we can from all various points to get a good feel for not -- for not just DCF as a whole but for DCF in particular, where the problem areas are. >>MARC DUBIN: I think Rick's question is an excellent question. Is it DCF's responsibility to affirmatively educate consumers about CART? Or is it the consumer's responsibility to know this and request it. Oy would just like to make the argument for why I think it is us DCF's responsibility more than the consumer's responsibility. In part because the ultimate goal is to provide effective communication -- that's the obligation that is everyone's goal. So if one is entitled to CART and doesn't ask for it, doesn't know about it, we are not really doing them a service. We are trying to effectively communicate with them. More importantly, I think historically, part of the reason that there are fewer requests for CART, and fewer people who use CART or need CART, knowing about it, is because historically, you never got it. And so, if you go to an agency, and you 32 | Page

recognize that you are not really communicating effectively, but you don't know what to ask for, and you have never been offered it before and the notice doesn't really tell you about it, I'm not surprised they are not asking for it. And it does cost as much as Sign Language Interpreters cost, and there are fewer providers. So for rural communities in particular, it costs even more, because you have to have them travel. I know in the Keys, for example, when DCF last year came to marathon, Florida, and did a meeting about its annual report, we had an individual who wanted CART and made the request, and DCF had a CART provider brought in from Fort Lauderdale and they had to pay for travel from Fort Lauderdale to Marathon, round trip. So there is going to be a situation where there's a financial burden to be able to provide these services. If the person who needs the service doesn't know to ask for it, I think we should affirmatively start out by educating about that option since it really hasn't been out there before. My recommendation is to start with the veterans programs. That is more likely than not where this population that needs CART will be found. My suggestion is to review the requests for CART from the veterans programs around the state, and really make sure that the flyers and the notices particularly in that population really highlight CART. >>MICHELLE RISKE-MORRIS: Anybody else? Valerie? >>VALERIE STAFFORD-MALIS: I just had a question. Thinking about the site visits and the focus groups from the activities standpoint, did you find it valuable in building those linkages between the DCF service providers and the advocates so they could develop their own local think tanks like we talked about at the last meeting? >>MICHELLE RISKE-MORRIS: Well, unfortunately for us right now, there was the disconnect that what we were hearing from the facility was not the same as what we were hearing from the individuals who participated in the focus group. So actually more the first step here is going to be remedial measures and corrective action plans with the facilities. Because what they are telling us, unfortunately, is not what in all cases is occurring. So I think by doing that corrective action and doing that remedial measures, you will start to forge those communications. And then after that, we also went to a meeting with a contract provider, two contract providers. I don't know if Shana was getting a lot of phone calls, because we started providing her information at the contact because we were at one contract provider and unfortunately for us, the line staff that we were interviewing said, well, I was working with an individual and he was hard of hearing, and he requested a Pocketalker. And I said, did you provide him with one? Well, no. He said talking loudly was okay. And again, I am getting to where this problem is staff perception versus client perception which has to be corrected. But other than that, I said, well, why didn't you provide him with one? He said, well, he made the request. And he did. You could see where he made the request on this SPOC. Unfortunately, the SPOC misunderstood it and assumed that they had to go out and purchase one for him specifically. And so we had to educate the SPOC and let them know that, no, you have to have them available at your facility, though. And so I think they might have -- she might have actually contacted Shana about getting that. But again, some of these, when we are going out and doing the site visits, it will be educational as well, because there is still misunderstanding. Now, that being said, hopefully after the training, which goes out to both the SPOCs, the direct service providers, and the employees who have the direct contact, when I come out and do site visits again, we won't hear that. But we are learning things. And one of the things about the site visits too is that because we are pilot testing, we are learning more and more things that we need to be looking at and inquiring about so the forms we are utilizing, we are constantly making notes, add this, change this. Because monitoring can never be stagnant. And also, what you monitor today, 33 | Page

agencies get familiar with what you are monitoring them on, what questions you are asking them. Guess what? Next time you go out, they are going to know what the response is, because I have seen it done. So you constantly have to kind of change up what you're doing. And we'll surprise people. He we went to a state hospital and they didn't know we were going to interview clients. It's a state hospital, they are there. We are sitting there at the meeting, saying what type of services have you provided? And they were talking about some of the clients, and we said, well, let us interview one. And they said, okay. So, you know, we interviewed a client. We walked back, and there was like six of us. They are following us. You know? We get to the room, they are following us. We're like, no, we don't want you to come in the room with us. You know. They did provide one staff person, because the client did indicate he became violent -- he can be violent. He told us that right off the bat. We sat in there and talked to hip and he had hearing aids. We asked him, do you have difficulty working with staff? He said oh, no, it's fine. But when they talk to me and turn their heads I can't understand them. He's reading lips. So we had to go back, we had to talk to them about what are you doing for him? If you are providing him with programs and services, how are you communicating with them? So it was a shock to them. Now they have to revisit what they're doing. So some of this is a learning experience. But we try to be flexible in what we do, because sometimes when you go out there, when you are actually doing a site visit, something may, you know, click in about, let's look at this. You know? I also have to add real quick, I forgot to mention, we are going to be doing unannounced visits as well. So in addition to announced visits, we are going to be doing unannounced. And we are going to try to use something such as the secret shopper where you come in there to see how the facilities are doing. And I'm strongly recommending it with the Access facilities, that I think those are some perfect examples of where you really need to look at someone coming in off the street, and how are they being treated, and how are they communicating with that client. So we are going to be meeting those as well. And I think those are something that DCF intends to continue on after, as part of the monitoring plan, those unannounced visits. >>MARC DUBIN: Michelle, I was wondering if you were thinking of developing like a frequently asked questions as a result of some common results that you're finding in these interviews and visits that would help others know what kinds of common errors or ways to improve things. I was wondering what your thoughts were on that. >>MICHELLE RISKE-MORRIS: I think that's an excellent idea. The way that we have it currently right now is, every time that we go to site visits and we write up the reports, we're communicating information back to the training staff so that for all of the refresher training, the refresher training again is not just what they did previously; that it's an evolving thing, that you start looking at what we have found, where you need to train staff. It is evolving. I do think doing the frequently asked questions is also an excellent idea. >>SHANA WILLIAMS: Before we get off of PockeTalkers and Ativas too far, after you made the referral, we looked around and we are an authorized dealer for those two products, so I think that the deaf service centers, we need to compile a list of agencies that are direct vendors for these products, because we can then pass those savings to you as DCF agencies. >>MARC DUBIN: Many, many, many months ago we talked about other disabilities, particularly issues about provision of Braille and printed material in alternative formats. And I know that it's not part of the settlement agreement, but I am also kind of wondering whether that's something that as you are doing these assessments, it might be worth capturing, because that's obviously a still ongoing Title II obligation and to the degree you are having these contacts and trainings, that is a 34 | Page

pretty simple one to fix and be sure it is doing right. Spoke while developing the monitoring and training, you might want to consider capturing that as well. I mean, there are other ADA issues, like accessibility. But the Braille, large print, alternative formats is fairly easy to identify, make sure that the notices provide an opportunity to make those requests, and then capture what is happening and fix it. I just wanted to make that one suggestion. >>MICHELLE RISKE-MORRIS: Just to let you know, we are captioning everything from the interviews and focus groups. And like I said, we received information on other state-operated programs that were not DCF-controlled. But we ensured that we got their information, and got those contacts for those people. Although they are probably not going to be heavy because we put information on the board, who you can contact and where to go to get that information. But it's their responsibility, so ... I don't really have a lot more on the actual site visits, because I have been talking about those. We did start, though, in Broward County, Circuit 17. And the Fort Lauderdale area. And we visited two Access programs, and two contract providers. Three contract providers? Three contract providers. And this week we are in Orlando, and so I think tomorrow we are actually going to an Access. We have been to Adult Protective Services and two child protective service programs. And is so we are continuing to do those monitorings and learning a lot from them. The monitoring, one of the things -- it has to be in-depth, they can't just be cursory. We find as we go out and do the site visits, we need to allocate more time for doing these because we want to interview as many staff as possible. Because you you really do learn a lot from staff. While I think it's important to interview management, the SPOCs, some supervisors, interviewing line staff, in a variety of areas, is important. Plus reviewing the case files, having the focus groups, doing the interviews. So each one is very intensive. So this is part educational for ourselves as to what works best in this particular area that we're monitoring, and you will see them accumulate into a more solid monitoring plan, which we will then carry out. Our next round of site visits will be in August. So the first two weeks in August we are doing another round of site visits in the Tallahassee area and Pensacola area. We also have site visits scheduled throughout the remaining 15 months as well as individual, weeklong site visits at three of the state hospital, because we are treating those more intensively. Working with them, when we were at one hospital, they had an individual who they did provide a certified interpreter for each time that that client interacted with families. Some family would come, they would ensure that the interpreter was there. If he had to go to an appointment or his therapist came, they ensured it. But when we asked him, we said, well, you say that your staff runs programs all day; you don't just sit around at the facility during programs. How do you communicate during the program? They tell us what they do. We said, are you sure? How do you communicate with them? That was one where they couldn't quite give us, you know, what they were doing. So they are going to have to correct that. Unfortunately, he was not there. He had already left, so we couldn't talk to him. But we would have. >>MARC DUBIN: Could you share with us in the Broward County visit which ones you visited, please? >>MICHELLE RISKE-MORRIS: Myself, I can try. I am still learning all the various names. We went to the Access center in Plantation. We went to an Access facility that was in Fort Lauderdale -- Sony? I'm trying to think. We also went to the Adult Protective Services that was in Broward -- I know it was on Broward Boulevard, by my VZ Navigator. By the way, the VZ Navigators are great, except they are not foolproof. I was trying to go to the state hospital, and it was on East Cypress Drive, and it kept sending 35 | Page

me to CYPRESS CREEK. And when I arrived at the country club, I'm thinking, this cannot be! Fortunately, I was able to contact them and they directed me in the correct way. But the guards were looking at me when I was trying to go through this gate, and I'm thinking, this is not the hospital! (:-) And we went to Child Net, which is a contract provider. We also went to South County Mental Health, and they are actually a contract provider. I think that was it. South Florida State Hospital. >>MARC DUBIN: I just wanted to make a quick comment about video remote interpreting. Even though video remote interpreting may in some cases be a fine substitute for live, in-person interpreters, there have been challenges to whether, particularly in hospitals, the individual patient is effectively communicated with. I would just urge DCF to both reach out for expertise on VRI concerns, and test a little bit about consumers' responses to using video remote interpreting. >>ROBERT FIFER: Michelle, I keep coming back to the home scenario, and the "Just speak louder." Let me start off with a question. When a DCF worker is completing the interview with domestic violence, for example, in the home, and guidance and instructions were given, is there a validation check to say basically, "Tell me what you understand" before that person leaves? Or is it assumed based upon the flow of communication that the communication was effective? >>MICHELLE RISKE-MORRIS: Me personally, that I don't know. >>ROBERT FIFER: It's a general question. >>CAROLYN DUDLEY: Each of the programs have a risk assessment that they use, so they would go back and ask the proper question to the client as to whether or not they understood what was going on -- whatever information they need to make sure that they're going to be providing and referring to person to the proper services. >>ROBERT FIFER: Okay. What I'm thinking about is, I have had some adults play this game with me, and they say "just speak loudly." I have their audiogram and I know their hearing aid and I know they can hear me, but it is a game where they came back sometime later and said, I really didn't understand you. My hearing loss was getting in the way. You know, effective communication. What I would offer -- and if you do this already, I will never argue its success -- but rather than ask them if they understand, have them repeat back for clarification and validation what they understand and then document that, and that will be one way to eliminate that game in terms of effective communication that goes on there. >>MICHELLE RISKE-MORRIS: I just want to add one thing too. The training also has added a provision that if an individual says, "just speak loudly," besides document that, they are to follow up with correspondence to the client afterwards, letting them know the nature of whatever service -- you know, why they were out there -- so that in addition to just the communicating at that point, they follow up with correspondence reiterating that information. That won't follow every instance. >>ROBERT FIFER: No it won't. But at least they can help reduce the number of instances where they are playing that game and they say, well, I just didn't understand! >>CAROLYN DUDLEY: And we had that happen, had an API tell us that yesterday, in an interview, that the person, they are playing games. So she does go back and repeat, are you understanding? And when she writes the report, that information is in there. >>ROBERT FIFER: Yeah. But the question, "Do you understand," is not the same as having them tell you what they understand. And that's the point. >>VALERIE STAFFORD-MALIS: And if I could be forgiven for inserting a personal anecdote that kind of ties into this, I can tell you from my own personal experience as a person with longstanding hearing loss, even if I hear it, it doesn't stick. They tell me 36 | Page

that's some kind of auditory processing disorder I might have from all those years of sensory deprivation or whatever. But anyway, if you are dealing with someone with hearing loss, it's never a bad idea to jot down notes and send that person out the door with it. If I see it, I will take it with me to my grave. If I hear it, I probably won't remember it 30 minutes from now. >>RICK KOTTLER: Wait a minute. We have Lois. >>LOIS MARONEY: As for playing games, that does happen. But that's not the only factor in this. A lot of times they think they understand. Their speech work is guesswork. And they are guessing and sometimes when they guess, they're right. Other times when they guess, they're not right, and they don't know it. A lot of times, as Valerie said, when you go back to an appointment -- I just had a client who went to VR, very late-deafened, and I taught this client about CART, and now they get it in the counseling session. They never knew about it. Anyway, they went to VR, and I asked him what happened at VR, and he could not tell me what happened at VR. He could not retain any of the information. Okay? And going back to that CART discussion before, I'm thinking, please let us not go backwards with CART because it's expensive or because people don't know about it or whatever. I think the point is that we want it in the policy and procedures and we want all the staff to know about CART, and I think we also want to educate, as Marc said also about it, for liability reasons, because people will think they understand it or are guessing and not really understanding. >>ROBERT FIFER: You know, a couple of good points have been made. Coming back to the validation questions, to have them repeat, this would be a good universal thing for everyone, whether there's a communication problem or not. There's a lot of research on memory. You may have an auditory processing problem or not, but whenever there is stress, not much is remembered. The magic number is 7. You remember 7 numbers, nothing more. But when you are tired or stressed, the number of items that you remember is reduced to what is called "the recency effect," and that's the very last item that is discussed. So if there are several items that must be remembered, then the validation can help refresh that memory so that that person is left with information from the personal contact; and then the follow-up with the documentation that you mentioned would be very good. That would be very good as a general principle for everyone, but particularly important if you are dealing with a communication issue. >>RICK KOTTLER: Michelle, I want you to think about this before you start. I think we have a meeting next April or May. I would be interested in seeing how your results compare between now and next May, because the training, most of it, will have been accomplished by December. Am I correct, Marsha? >>MARSHA RYAN: Yes. The settlement agreement says that by December the 31st we will have had all DCF employees trained and by the end of March of 2012, all of the contractors will have been completed. >>RICK KOTTLER: So May will probably be a good time. Not to add too much into your basket that you've got to do, but if we could possibly think about that and at that meeting see where we're at and see what the difference is, see how effective the training will be. That will tell us a whole lot. But I think what you are learning now is great. This is wonderful stuff. >>MICHELLE RISKE-MORRIS: And just so you know, in May, we'll be doing Orlando again. So we will be doing a site visit in Orlando in May, and with a focus group. So hopefully then we'll start to see a change. And some of this is important I think to stress, too, when we talk with staff, many staff -- and they have reiterate to us the difficulties -- that they may have received training back last year, but they don't work with individuals or clients who are deaf or hard of hearing. Some organizations may have, you know, four instances within a year. And then others may have it more repeatedly. Especially like API programs where they're more than likely. So when we ask 37 | Page

them questions, because we do ask them, do you understand what video remote interpreting is? Are you familiar with CART? We do ask them those questions. And they say, I have never heard of it, then we educate them. Then they look at us and they say, I think this is great, and hopefully in a refresher training, it will continue to be with us. But I have worked here for seven years and I have never met a client or a companion. So some of it I think is going to be constant education, keeping constantly requirements up. So in that preventive mode, when they do have occasion to interact with a client who is deaf or hard of hearing, they know what to do and to ensure they don't rely on the old stand-by of we can write things down and communicate that way, that's sufficient. >>RICK KOTTLER: Have you scheduled next May yet? Do you you have them on the calendar? >>CAROLYN DUDLEY: The review is scheduled for the weeks of May 14 to the 25th. >>RICK KOTTLER: If we could arrange to meet around that time just to see what the end results are at that point. >>MICHELLE RISKE-MORRIS: I don't have a problem with that. The only thing is, with coming to Orlando this week and doing an Advisory Committee in the middle of the week, that took out one day that I wanted to do a site visit. But we could maybe arrange to have it like maybe the week after the site visit? Something like that? >>RICK KOTTLER: Yes, we could try to coordinate our meeting so that you have still a feeling for what happened and we could discuss that. >>MICHELLE RISKE-MORRIS: Mm-hmm. >>ROBERT FIFER: Well, in terms of remembering things, I agree, dealing with the deaf and hard-of-hearing populations will be an exception rather than the rule, given the totality of population that DCF deals with. I have a memory like a sieve. Not much is retained there but usually I know where to look. And if DCF could have a Web page connection with a lot of resource the material that we have reviewed and talked about to where if someone says, I don't remember what this is, but I do remember where to look, that may help with refresher, because many times the user loses the situation and you don't remember, but if you know where to look, that would be great. So a Web page would be a suggestion from me. >>CAROLYN DUDLEY: We currently do have a Web page that is under the office of civil rights, and we have listings of the various organizations or policies and procedures. And as we develop material, as we learn various other organizations, those links will be placed on that page. >>ROBERT FIFER: Okay. I am offering a suggestion. Not a Web page under the OCR page but a page unto itself, is so that they can go to the search box on the DCF home page and put in deaf, just that one word, and it takes them to a link for a page unto itself. >>CAROLYN DUDLEY: We do have that. It's on our intranet page. >>ROBERT FIFER: Perfect. You're ahead of me. >>MARC DUBIN: I had occasion last week to look at your page, I think it's excellent. It's got a lot of great information about the settlement and everything else so I want to commend you for that. I want to suggest in the several months down the road you consider developing a one or two-page newsletter that goes out to everyone ta brings people up to speed, that gives the links to the Web sites. Doesn't have to be comprehensive, but a lot of people want to know where things are, where things are going, what they're supposed to do. And perhaps developing a newsletter might be a way to do that. >>MARSHA RYAN: I saw Carolyn blanching. I think that would be a great project for the 504 coordinators to do! >>RICK KOTTLER: I thought you were going to volunteer Merlin. >>MARSHA RYAN: Yeah, might be a good project for the project manager too. I 38 | Page

think we have our hands full. One of the things we have been thinking about, I will raise my hand at this point, is that when we are taking in data and looking at the monitoring, to me it's going to be extremely important and we're going to be all hooked up and geared up to be taking in information, you will be hearing things as well in the community, because you are out there. And that report, if we are monitoring just the community, and doing focus groups from our perspective, again, it's a perspective issue, if you are hearing things, that data also should be collected in some fashion and made known. You will see hopefully some recognition and gain of knowledge in the community and the services that we provide. The story on the street will no longer be "don't go to DCF." It will be a better story, if you will. The other thing is that I'm not sure that training can take credit for all of the results. Hopefully they will all be positive results, but I don't think that training itself can take credit for that. I think it's going to be communication, communication, communication, over and over and over. And it's going to have to be from every angle and every person. The 504 coordinators with their relationship with the SPOCs, the supervisors, the relationship on the scene when the actual services are provided, to never let anything go by, whether or not they are a SPOC. If they are a supervisor and have responsibilities. All of those things in collaboration should make a difference and we'll be getting data back hopefully from our focus groups and other places of where that's actually coming from, not just a training perspective. So I would like to take credit for all of the gain, improvement, but I don't know the training itself can take credit for all of that. >>RICK KOTTLER: I would agree with you, but I would think that we are going to see some dramatic chinks between now and next May. We hope to. Because right now, you are dealing with pretty green territory, and once it's covered and once people get the word out and they will get most of it through the training, that's what I'm expecting. If we don't see it in May then we have to come back and figure out why. >>MARSHA RYAN: Training is a great place to start and I think we have identified it adequately and appropriately so. Appropriately, having the players that are the DCF staff, the SPOCs, the executives, the direct service -- everybody getting the information and then just keeping at it over and over and over, that's how, repetition and training. It's just, an vent of training, success can't be defined with one event, that one training in a year. We are going to have to continually be in front of our staff. >>MICHELLE RISKE-MORRIS: I just wanted to point out too one thing that was nice to see, although I haven't had a chance to really look at it, when we were at the training yesterday where an individual had come to the SPOC training, all of his staff had laminated cards that are now with their IDs, so with their IDs, they have laminated cards that has all the appropriate resource numbers so, if they are out in the field and they need and interpreter, for example, they have the phone number to call. If they needed a language interpreter, they have a phone number to call. They said that it also incorporates numbers to call when you just have general resource questions, like someone asked them for something that they're not familiar with. They have numbers that they can call. And they carry those out in the field with them. They also were the first organization -- or program, that when I asked them, are you familiar with the auxiliary aids and service plan, every single one of them knew what it was. Knew how to access it. They had it posted in the lobby. They had it at the front desk with the receptionist that was there. She had it. They all knew that it was available on the Internet. Most of them had actually taken the resource material which is an attachment to that, that has resources in the community for the various types of auxiliary aids or services they need to look into. But that was nice to see that. Now, we are hoping that that is as a result of training and not just that this SPOC was the poster SPOC for DCF. (:-) But it was nice to see that here was somebody that actually had gone to the training and had actually gone out and trained their staff. 39 | Page

>>RICK KOTTLER: One more. >>MARC DUBIN: I wanted to talk for a moment about the focus group meetings and where they're held. I just wanted to urge you to consider access to busses for where you are holding these community meetings. AHCA is right now in the process of holding community meetings and there has been an uproar about their failure to hold these meetings anywhere near where the disability community can get to them. I want us to avoid that. >>MICHELLE RISKE-MORRIS: Yes. We are trying to look whenever we do a focus group to make sure it is in the most advantageous location so that individuals can arrive there. The one we did was at the local deaf service center, but that room was too small because we had had so many individuals that were interested and had arrived. Also, again, we are trying to think about using public libraries where they do have the conference rooms so they can accommodate a much larger audience, or other facilities. We are kind of going against having it at the actual, like DCF facilities, because we think less likely that people will come. >>MARC DUBIN: I do want to highlight the transportation issue as much as the architectural accessibility questions because for many people they are just not going to be able to show up if they don't have access to a very short walk from the bus stop. >>RICK KOTTLER: Okay. We need to begin to wrap this up. Do you have anything else? On this subject? >>MICHELLE RISKE-MORRIS: No. I am just -- we are going to continue on doing the site visits. I am going to be finishing site visits this week with Carolyn, and then I will be writing up the site visit report. I will let you know practically from every site visit, absent one or two programs, there will be corrective action plans that we are suggesting be put in place, because no one agency, you know, did not have problems. We did have instances where some agencies were not completing the forms, or completing one form and not the other one. We couldn't verify that they were completing the forms in all situations when it was necessary. So there's, you know, there's still a lot of work to be done. But, you know, we will continue on with the site visits, and I will continue on the report with the site visits as we do that. Hopefully we will start to see an improvement. >>RICK KOTTLER: I think y'all have made a great start. This is good stuff! Suggestion. Since it's 2:00 now, if we, rather than take a break, just go through till 3:00 and then call it a day, what do you think? >>ROBERT FIFER: I like that suggestion. >>RICK KOTTLER: Valerie, you are excused, you can go. You bet. Okay. What other concerns? >>LOIS MARONEY: I know from my late-deafened eyes, I need a break. I don't know about other people, interpreting, or CART, if they need a break, but I know that I do. >>RICK KOTTLER: Five minutes. Okay. Ten after 2, we will start right back up and then we will be done. >>(Recess taken at 2:04 p.m.) >>RICK KOTTLER: Okay. We're going to keep this as kind of a general discussion. And I think we want to start with the aid-essential versus non-aid-essential. I know this is something that we have talked about and talked about and talked about, but there is still concern. So let's go ahead and start, Terri. >>TERRI SCHISLER: I appreciate you allowing me to address some of these concerns. As you know, I wasn't on this group from the very beginning so I haven't been able to take advantage of those discussions. In reading all of the materials that we've been presented in the last couple of weeks, for me they're all new materials, I had some concerns or some questions. Most have been discussed today. So some is a learning process on my part. But what I want to discuss for a few minutes is all relating to the provision of 40 | Page

interpreter services. Because you didn't have anyone here that was an interpreter. You have people who know a lot about interpreting, but I really feel like there was some additional insight that might be relevant. And as I come to figure these things out, I understand that the settlement agreement is what we have to go by, so the definitions that are in the settlement agreement, we can't change those, or possibly we could ask them to be changed, but we have to go with what's in the agreement. But the use of the terms "qualified" and "certified "are problematic. I think you guys have already made some changes to the trainings to accommodate that distinction. If we can avoid the use of the materials qualified and certified as much as possible so we don't confuse issues, it would be really great. If we have to stick with those definitions that they are, then when you interact, or when the staff people interact with those service providers, and you are saying that you need a qualified interpreter, or you need a certified interpreter, those are going to have very specific definitions within my profession, so you might get some miscommunications when we don't use them consistently from your perspective to our perspective. What I also kind of want to clarify, today's discussion has clarified that, the settlement agreement is mandating that we use, for all aid-essential situations, that we must use a certified interpreter, and I 100 percent support that. There's nothing here that I'm going to say that says, I really think you should use somebody else. You know, you don't always have to use a certified. No, I find that to be a standard in all of the opportunities that I work in, we want that to happen. The reality is that you have to work with the resources that you have available within the state. And you are going to find that to meet those requirements, the two-hour time limit and the next business day requirement, that you are going to really have some situations where that is impossible, there is no way that you can be a get a certified interpreter within 48 hours or possibly within four or five days. The if you are in a rural interpreter where there may be zero certified interpreters or maybe one, that person could be out of town for business or pleasure and not available to you for a week and you may not be able to find anyone else willing to drive that far to provide that service for you so there is a limitation to the resources that you are going to be using and I haven't seen anything really that delineates what your alternatives are. So if we go back, if we talk about the aid-essential versus non-aid-essential services, I know you all discussed this at length but I want here, I really want to make sure that we communicate that. From my perspective I don't see those as separate entities but really you have a continuum of situations so whenever you are providing interpreter services we evaluate the needs of that situation and its complexity and the length, et cetera. In our profession we are accustomed to determining, would another interpreter be qualified for that situation. So if there's low risk and there's low intensity or duration, then we can provide you another interpreter who is qualified, without being certified. And that meets the letter of the ADA. I'm not promoting the use of lesser qualified interpreters, but the resources has that you are going to find out there might benefit you if we can have a better assessment of the situation to be able to produce or provide an interpreter who does meet those requirements and is qualified without being certified. Using the two definitions of certified, the settlement agreement talks about certified contract and qualified staff. And to me, I am seeing a gap there, because there's another group that I'm referring to that are qualified contract interpreters, those people who might have a Florida QA 1, 2, or 3. So the definitions of those two terms in the settlement agreement are preventing those other people from being used. If your staff members -- and I am not trying to diminish their services or their capabilities or qualifications -- your staff members who you have listed who are going to be going to be tested, they are going to be taking the QA in the next few months, I know that we're working on getting their memberships with FRID and RID and the

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paperwork processed. If those staff people take the QA and become a qualified staff interpreter or staff person, then they are qualified at a QA level. They are not certified. They may become certified, but this moment they're not. And my question is, why are we eligible to use those qualified staff and not qualified interpreters as well? And if I read it correctly, those qualified staff members would only be used in non-aid-essential situations. But you have very few -- right now you you have zero staff people, so you are going to need to meet the need if there was a non-aid-essential situation, how are you going to meet that need if you don't have any -- (pause for teleconference operator to say if there is no response the conference will end) -- how are you going to meet the need of that non-aid-essential situation if you don't have qualified staff? Are you going to bring in a qualified person for a non-aid-essential situation? Those are some of the concerns that I have; answering those questions. I did some statistical analysis over the weekend, and I have given you over on that side of the room a copy of what I have and I can send you the document electronically but I looked at and tried to determine what the total number of certified interpreters are in the state, and if you go onto the FRID Web site you will see that we have about 313 certified members, but there are certified members who are not participating in our state organization, so I went to the national organization Web site and got the list of all the nationally certified which should be the total list. But I think that there's some limitations to the database search, but when I searched for certified members in Florida, the final number that I came up with is greater than the number that I got on that database search. When I compared the two groups and then eliminated duplicates, I came up with 441 interpreters in the state who are certified. That's probably a decent number. Florida es one of the large ever state affiliate chapters, third largest in number of members, and I don't really know the number of certified members. But when you start looking at where those interpreters reside, geographically, if you look at the center part of the state -- and this is pretty self-explanatory -- I mean you have all seen can assume these results. It wasn't a surprise. If you look at the nine counties in the state from the Tampa, St. Pete, Orlando, Daytona section, those nine counties comprise 45 percent of the certified interpreters in the state. If you go to the top 15 counties in the state, that's 80 percent of our certified interpreters are found in only 15 counties out of 67. And so that's Escambia on the far side of the panhandle, Jacksonville on the other section, and the Miami, Ft. Lauderdale area. So you have 15 counties that hold 80 percent of the certified interpreters. There's 28 counties who have no certified interpreters. So there's 20 percent that's kind of scattered out throughout the rest of those other counties. Geographically, you are going to have a hard time meeting the requirements of the settlement agreement without another alternative. So again, some more of my questions go to the critical questions, which is what you are using to determine if it's aid-essential or non-aid-essential and what kind of services you need to provide. When you start talking about is it scheduled, is it aid-essential, you are going to come up with some scenarios where it is aid-essential and it's unscheduled but it's a, you know, whatever the scenarios are you are going to you come up with some situations where I'm not sure -- I don't know from reading the materials what your next step is. If it requires a certified interpreter and you can't get one within 48 hours, what is the plan of action? What are we to do in that situation? >>CAROLYN DUDLEY: From my understanding for most of the regions, when they entered into the contracts with the interpreter agencies that they are using, that was a part of their negotiation, so they would be the ones that would have to tell you if there is an issue that the provider cannot come or the interpreter cannot appear, then they would be notifying the agency. But we have not had a problem yet. Everybody's been on time and we just haven't had the issue at this time. 42 | Page

>>TERRI SCHISLER: Where I live in Pensacola, the interpreter service providers and deaf service centers are in Pensacola or in Tallahassee and that's a three-hour time span in there where it takes you three hours to drive from Pensacola to Tallahassee. So the Pensacola interpreter services, most of those four or five counties across there, and from the list you will see there are 12 certified interpreters in Pensacola, but the majority of them have full-time jobs, they work in the school system or work in VRS full time or they have contract jobs that they're employed and this might not be one of those 12 who can drive three hours away in a two-hour time frame or in a 24-hour, 48-hour time frame. So I'm -- I want to encourage you all to make sure that you provide some of these other resources to your staff so that when this comes up, they will be prepared.

One of the things that I would like to be considered is the use of those -- or to redefine the use of qualified contract interpreters. We can certainly probably all agree that we don't want QA 1 interpreters working in these DCF situations but there are many QA III interpreters who are very qualified in that there are things going on in our profession that are going to begin to prevent some of these precertified interpreters from jumping the hurdle here and becoming certified. Effective next June 30th, you have to have a bachelor's degree to take the test, to see if you can pass it to become certified. All of the currently employed interpreters who are not cert fight and who do not have a bachelor's degree, will then be prevented from being certified unless they are able to navigate going back to school and getting a bachelor's degree and for many of those interpreters, that won't be something that they can deal with. So I'm kind of personally anticipating that you're going to begin to see a levelling off in the numbers of certified interpreters, at least temporarily, and a building up of the numbers of QA III interpreters. As they progress up from the QA III level then they will stagnate as interpreters because they don't have a bachelor's degree, can't take the exam. So be sure you have enough resources to meet their needs whenever and wherever you need them, that is going to be a concern. I don't know that that's been addressed. Being able to take advantage of those additional resources I think would be, you know, something beneficial to everybody. In those remote locations, if you look at the top third of the state, it's very sparsely populated with people, but with interpreters as well. So from Pensacola to Jacksonville was about a 5-hour drive and down south through Ocala and Gainesville there are very few interpreters in that whole area, and in those remote locations I would encourage you to be utilizing VRI services. There are some definite concerns about VRI services, when and where it's appropriate. I gave you all links in my feedback to the standard practice papers for different interpreting situations. And there's a stimulated practice paper on VRI used in a medical setting where the patient's lying flat on their back and may be looking at a monitor beside them or in front of them where if the monitor is not able to be moved, it is difficult to have good communications with that service. But I think VRI might also be -- I mentioned finances earlier. It's not that that's a priority whether it costs a lot or not; you have to provide the service. So if it costs, it costs. I assume that's not a consideration. But VRI services can be billed on a smaller increment, 15-minute increment, rather than the hourly or two-hours increment, and I think in some cases it might be cost-beneficial. But it is readily available at any location. You can get laptops and make that available in some of these remote locations or out in the field. The laptop can be taken with you and be used to provide that VRI service. Again, I would love to have a live person, certified interpreter, in every situation. That would be the ultimate goal, Utopia, if they are always there and always available, ready when you need them. But they're not going to be, and there are going to be situations I think that you need to be prepared to deal with. VRI is one option. Considering the use of the QA III individual interpreters in limited circumstances,

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maybe further defining aid-essential; and the FRID Web site has these descriptors that help you to understand what types of situations they should be or should not be used in. They should not be used in a legal situation, which may involve a lot of your instances, may be legally based or have a legal impact to an individual.

>>VALERIE STAFFORD-MALIS: I have copies of those standard practice papers in my car that I would be happy to give y'all. I used them yesterday for some law enforcement training that I did. But there are some very definite considerations for when VRI is not appropriate. So I will get those to you before you leave. >>TERRI SCHISLER: So those are my concerns, and I don't know if you all can answer that, or if you have a plan in place, or if you feel like these have been addressed sufficiently, but, you know, just further defining aid-essential and non-aid-essential and making sure we have the resources we need to be able to meet the mandates of the settlement agreement is my concern. >>CAROLYN DUDLEY: I will take this back to Gail Hoffman at HHS and let them provide an answer for us, because they have specified, as you well know in the settlement agreement, that we use qualified or certified interpreters, so this is something that they will have to give us a recommendation on. >>RICK KOTTLER: One at a time. Valerie first. >>VALERIE STAFFORD-MALIS: This is Valerie. As I am thinking about aid-essential services I am think being this listing about the ten service areas that DCF is involved N. I would think that any client trying to access any service in that area, about by definition, that communication would be aid-essential. >>MARC DUBIN: I want to urge DCF to explore what communities need video remote interpreting services in order to accomplish the provision of certified interpreters. A very brief story, in Key West, prior to all of this, prior to this settlement coming into play, we found that there was not a certified interpreter in Key West and we had a psychiatric patient who was deaf who was being served by a volunteer interpreter who was, herself, deaf. That was how bad it was. And over the space of a year, we have discovered that there was no certified interpreter available, and we didn't have any options, so what we did was, we worked with all of the agendas in the Keys to get video remote interpreting. What I want to suggest is that it's quite possible that Sheriff's Offices and the courts throughout the state already have video remote interpreting in place. DCF might consider trying to partner with them and seeing what is available in terms of particularly these communities that don't have certified interpreters, in order to provide those services and partnership with those communities that already have VRI in place. And I think that I would agree that we should not be diminishing the qualifications of the interpreter services that are required here. We should be doing everything we can to get video remote interpreting as broadly available as possible. Particularly in the Miami area. You know, we obviously have a great number of certified interpreters. We also have people who have Creole as a primary language, or Cuban; Cuban Sign Language. And video remote interpreting may be an appropriate way to provide services to them. So I think for a variety of reasons, video remote interpreting needs to be explored far more than it has been. >>RICK KOTTLER: Anyone else? Okay. Any other subjects you want the to touch base on? >>ROBERT FIFER: Observation? >>RICK KOTTLER: Hold on. Shana? >>SHANA WILLIAMS: Michelle, you had a Deaf Service Center providing consultation to you. What happened? Are they still involved with you? >>MICHELLE RISKE-MORRIS: Yes, they are still involved. They have been reviewing all the information and providing their comments and feedbacks on that. They're actually he -- they have already approached me about the issue regarding the 44 | Page

certified. They said, you know, a certified in every case? They are like, in Ohio, they have never even come close to that. I said, it is a requirement of the settlement agreement. Although, after speaking with Terri and encouraging DCF that they may want to look into other instances, because if we are going out and haven't visited those other areas out, if we are going out there and someone has requested an interpreter and they are not providing it timely, they will be cited on the agreement. I mean, that is the end result, they say, we will be cited, because 'it's a requirement and they can't do that. So to the prevent that, they may want to start looking at other options. I do know in the Suncoast region, I think they are using a video remote interpreting more often than -- in the southern region, I'm sorry -- so I do know that video remote interpreting is becoming more popular in other areas. >>ROBERT FIFER: I just want to echo a comment I made three meetings ago now. Especially after having missed a couple of meetings. We're making progress. As was mentioned earlier today, we are not where we want to be. But compared to where we were a year ago when we started this process, we have come a long way. And I want to congratulate you all on the hard work. I want to congratulate you all on this panel for the hard work. We are nitpicking to some extent and that's a healthy sign because that means we are getting down to the detail and not the overall structure. So bear with us, be patient with us, but I am very pleased with what I see with regard to the framework of progress, and a lot of the details and the learning that has taken place over the course of the last several months. >>RICK KOTTLER: Anyone else? So far, for the next agenda, we've got, let's see, we're going to have CART, and we're going to talk -- spend some time trying to flesh out the companion portion of all of this. Anything else that you think you would like to discuss at the next meeting, please e-mail me within the next couple of weeks, because this meeting is going to come up on us real quick again. Is there anything else? Give me one second, Susan. What we were discussing earlier, is there any way or any desire to capture information on service folks coming into the different centers? I know we have it included in the training package, but there's still resistance out there to service dogs, but they are getting more and more frequent, particularly in the hard-of-hearing population. I was just wondering if we want to capture that information, but just to make sure that the centers are aware that those dogs have to come in. Just a thought. >>MICHELLE RISKE-MORRIS: I mean, one thing that we can do in the monitoring piece is, when we talk to the SPOCs, we can insert that question, to say, you know, have you had that occurrence, to start maybe at least capturing the frequency of it with each of the SPOCs. I think that putting it in with the direct service, we can -- since we only randomly interview some people it's not going to be a true representative sample because sometimes it's hit or mission who you interview as to who is there that day and sometimes depending on what time you go. Like yesterday we interviewed people we interviewed people who worked nighttime investigations, just by the time we were there. But we can insert that question, just to start to trying to capture it. >>RICK KOTTLER: Something to think about because it's out there. Susan? >>SUSAN HERRING: Thank you. I just have a minor question. As I leaf through these documents and these training manuals and the instructors guide and the participant guide -- and I have not gotten through all of them -- I notice there were a few discrepancies and some -- should I e-mail that to somebody? Using the word if, the word they're, their, I have viewed a couple of those. Could I forward that to somebody and let that be corrected? Also improper use of terms like putting the subject matter, the person after deaf and hard of hearing. That is still being done in there every now and then. Not very often. I just wanted if we were interested in making it consistent and having it be correct. >>CHRIS RECINELLA: Any citations, anything like that, whether it's a minor, grammatical, people-first language, or any other issues we have been covering, please 45 | Page

do e-mail it to us. We have been going through this. I have looked at each of these manuals a thousand times, so your cold eyes are going to be a good safety net. >>SUSAN HERRING: I will e-mail that to you you. >>RICK KOTTLER: Along those lines, always remember, if it's dealing with the training and it's stuff like that, I think you can go straight to Chris or Marsha. Anything else that you need to distribute to us, always has to go through Merlin. Okay? July 20th is the next meeting. Go ahead. >>MARC DUBIN: On the service dog question I had a couple of thoughts I wanted to share. I was wondering, maybe DCF could ask its employees and its partners to identify which of their customers use service dog, and then, based on that pop lay, you could consider interviewing the customer to see what kind of service issues, if any, they might have. The other population to consider interviewing are the community of customers who are deafblind. I don't think we have really talked about them very much. I don't know how large a population that is within the customer base of DCF, but I would be interested in knowing what issues they're experiencing that persons who are deaf are not experiencing. >>MICHELLE RISKE-MORRIS: I was going to let you know that every time we do a site visit, we send out information about interviewing to all of the clients. So any client that DCF has, that may be deaf or hard of hearing, we send out the notices to them and invite them to be interviewed. So it is anybody. And it is voluntary, you know. They contact us and we either do it by telephone, or we pick certain days that we let them know that we are going to be at a facility so we can have appropriate services in place to meet with them. >>MARC DUBIN: But Michelle, might it be possible on the invitations to suggest that those who have service dogs are specifically those who are deafblind, are specifically those we are interested in talking about, so they know DCF wants to actually hear what their experience are like. >>MICHELLE RISKE-MORRIS: We can do that. I don't want anybody to get the impression when they get our letter that we are seeking to talk to some versus others. And I don't want, if we put that insertion in there, to have clients feel, well, they are just interested in that right now and that doesn't apply to me. So I don't know. I want to have it open so that anybody can come and talk to us. I mean, another thing, too, we do the advocacy surveys. Maybe in doing those survey, they might let us know as well, because we ask them, do you encounter problems, and we might be able to find information from them if certain areas are experiencing various problems as well. We request tap into that. >>This is Merlin. I was wondering from a project management perspective if the decision had been made whether the funding was restored to the Council so that that our committee could be continued to be sponsored by the Council and we could continue uninterrupted according to the settlement agreement and the interagency agreement. >>RICK KOTTLER: Well, here's the thing. Nobody knows. Where it is right now is, the Governor's office is talking with the University of Florida so they may, quote, unquote, financially house the Council at UF. We don't know where it's going to go. We have no idea. I did talk to Gail, and I told Gail that if we needed a nonprofit organization to basically fill in, that the Deaf Service Center Association would do that and that we would not change anything else, everybody would be the same people, the same -- everything would remain the same. It would just simply be a name change. So that's on the table. So at this point, from looking at the settlement agreement, you know, the settlement agreement said, okay, make the agreement with the Council, and get the Advisory Committee together. That's pretty much what the role of the Council has been up to anoint. So I don't know that it's a big issue if the Council does go away. The committee is here, and the committee is in place. The Council doesn't provide any 46 | Page

funding or anything else for the committee. So, you know, whether we have the council umbrella over our heads or not, I think it's just, you you know, everything goes along the same, but that's really Gail's call. So the easy answer to your question is, nobody has any idea! (:-) Any other comments? Yes? >>MARSHA RYAN: I just want to let you know, I saw Lois holding up the CD that we distributed around the room earlier today. I want to let you know what it is. It is the PowerPoint presentation for both the SPOC training and for the direct service training, and it is a huge file. We could not get it in any way, either through the Internet or through the e-mail process. It is not a zipped file, but it is PDF file. To make it smaller. And that's the only way we could get it to you. >>LOIS MARONEY: Could I have two more. I want to get them to the CART providers. >>MARSHA RYAN: We actually have two more that we would like to give to Lois. (:-) The catch is, these may change with the changes that we talked about today, the very final copy of the PowerPoint. If the PowerPoint doesn't change that significantly, we may not try to get you another CD until we have the final approved PowerPoint, and then we would post it on the Internet for you to go and download yourself, hopefully; if that would be acceptable. >>RICK KOTTLER: Sure. >>MARSHA RYAN: Because we won't see you again before it's approved, hopefully. >>RICK KOTTLER: Anything else? Now comes the favorite part of this job. We'll see you all in July. This meeting is adjourned. (Concluded at 2:28 p.m.)

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