II. DMH Central Office Liaison to Coordinate and Develop Services for Persons Who are Deaf.

1. The parties agree that Department of Mental Health (DMH) Central Office coordination, development, and oversight of services are necessary components of effective services to DMH eligible clients who are deaf or hard of hearing. The parties also agree that the actual delivery of community services by local service areas (Areas and Sites) is important to ensuring that such services are designed to meet local needs and to guarantee local accountability for the quality and appropriateness of services.

2.    To assure clinical expertise, DMH has and will employ on a part-time basis an individual in the position of Statewide Coordinator of Services for the Deaf and Heard of Hearing (Statewide Coordinator of Deaf Services). The position was filled on January 21, 2004, by a candidate, Lucille Traina, that both parties find acceptable. A job description for this position, that is agreeable to both parties, is attached as Appendix 1.

3.    The Statewide Coordinator of Deaf Services will report to Michael E. O’Neill, Assistant Commissioner, Mental Health Services.

4.    DMH will inform Central and local area staff of the hiring of the Statewide Coordinator of Deaf Services, her/his responsibilities and authority , and contact information.

5.    DMH considers the Statewide Coordinator of Deaf Services position to be one of particular importance and agrees to take reasonable steps to protect this position from future reductions in force or downsizing of DMH employees. Inasmuch as this position is a non-union, management level position, it will not be subject to employee bumping or similar personnel actions.

1. DMH Central, Area, and Site Office TTY phone numbers have been updated and published in the DMH Resource Guide and on the DMH Web Site.

2. By April 1, 2004, DMH will ensure that all DMH Areas and Sites have TTY machines that are working and have staff trained to use them.

3. The parties are aware of the availability of telephone relay services, and agree that such services may be used in some circumstances as a back up to TTY services. However, the parties acknowledge that TTY or TDD services are preferable and DMH agrees to ensure the availability of TTY services at its Central, Area, and Site offices.

4. DMH will work with its provider community, including PACT services, clubhouses, residential programs , outreach services and hot and warm line services , to educate them about the TTY services and to encourage its use or other appropriate technology to facilitate accessibility. The Massachusetts Commission on the Deaf and Hard of Hearing (CDHH) has offered to assist DMH in carrying out these activities.

1. DMH will employ no fewer than four case managers who are deaf and/or culturally and linguistically competent to work with deaf and hard of hearing. For purposes of this Memorandum of Understanding, these individuals will be referred to as “signing case managers.” DMH will replace the signing case manager in the Western Massachusetts Area who recently resigned with another case manager who is deaf and/or culturally and linguistically competent to work with deaf and hard of hearing. It is anticipated that this individual, when hired, will be located in the Springfield Site office, although he or she will have responsibility for deaf and hard of hearing clients throughout the Western Massachusetts Area and elsewhere. As noted in part V below, DMH agrees to recruit and hire three additional signing case managers. These case managers will be hired no later than July 1, 2004. One of these newly hired case managers will be assigned to the Metro Boston Area. The assignment of the other newly hired case managers will be determined by DMH, consistent with the principals described in this section.

2. Signing case managers will be assigned to local Area and/or Site-based case management teams and will be supervised by the Area Director or his or her designee in accordance with the procedures followed in that Area.

3. Notwithstanding the provisions of the preceding paragraph, the Statewide Coordinator of Deaf Services shall oversee and assist in the coordination of case management services to individuals who are deaf or hard of hearing. The Statewide Coordinator of Deaf Services will facilitate and encourage communication and sharing of expertise and experience among the signing case managers.

4. Notwithstanding the assignment of a signing case manager to a particular Area or Site, signing case managers shall be responsible to serve eligible individuals who are deaf or hard of hearing whose area of tie is a Site or Area other than that to which the signing case manager is assigned. It is anticipated that each signing case manager will be responsible for deaf and hard of hearing consumers in the case manager’s Area and in an adjoining Area.

5. All DMH -eligible clients who are receiving case management services and who are deaf or hard of hearing and use sign language to communicate shall be assigned to a signing case manager. In the event that the deaf or hard of hearing individual’s area of tie is an Area other than that Area to which the case manager is assigned, the Area Director or his or her designee may also assign a local case manager to assist the signing case manager.

6. The parties agree that it is clinically inappropriate for signing case managers to act as sign language interpreters for their clients. CPR believes that DMH should issue a policy forthwith prohibiting signing case managers, except in unanticipated emergencies, from acting as interpreters for their clients. DMH prefers to establish such a prohibition as a goal and to reevaluate the situation in July 2004 after the hiring of the signing case managers. The parties agree that their inability to agree on this issue should not prevent the implementation of other initiatives set forth in this Memorandum of Understanding. Therefore, the parties agree to continue to discuss this matter in good faith at the monthly meetings established in part VII, paragraph1 below. CPR agrees that it will not consider a failure to reach agreement on this issue as the sole sufficient cause to withdraw from this Memorandum of Understanding and to file litigation. DMH agrees that it will require its four signing case managers to report to the Statewide Coordinator of Deaf Services each time that they serve as interpreters, the circumstances underlying each event, and the efforts that were made to secure an interpreter. This information will be shared and discussed at the meeting scheduled for July 2004.

7. The parties agree that DMH-eligible deaf clients, in general, are more challenging to serve than DMH clients who are not deaf. Therefore, no signing case manager shall have a caseload larger than the average DMH case manager caseload.

2. Hiring of Three Case Managers. DMH will hire three Case Managers who are deaf and/or culturally and linguistically competent to work with deaf and hard of hearing. One will be assigned to the Metro Boston Area and the others to Areas to be determined. The cost of this hiring will be approximately $120,000 on an annualized basis.

3. Strengthening DMH and Provider Interpreter Services. DMH will take strategic steps to build its internal interpreter capacity by expanding staff resources and by offering additional reimbursement to current DMH or provider-based interpreter staff for increased availability. The exact cost of these initiatives is unknown, but is estimated to be approximately $100,000 annually.

4. Expand Flexible, Individually Tailored In-home Services with Specialized Treatment Availability. DMH will add supported housing or other intensive residential services capacity to the following Areas: Western Massachusetts/Central Massachusetts, through accessible residential and day services, for approximately two clients from either Area ($164,200); North East Massachusetts, for consultation, training and 1:1 support to maintain a North East Area client in a supported apartment program. The supported apartment program is specifically for deaf clients. These funds will be the start towards increasing the program's substance abuse treatment capabilities ($10,000); and Metro Suburban for increased residential and day services for one person ($110,000). These services will offer residential support; build clinical expertise to address unique client issues such as substance use and trauma histories; and assure employment support resources (through local clubhouse or SEE program) to help clients meet their work interests and goals. The annualized cost of these services will be approximately $471,200. An additional annualized amount of $388,800 will be allocated to augmented services based on a review of existing resources, client needs and community input. The review will be completed by June 30, 2004. The previous study by Dr. Mary Ellen Foti will provide a base of information for this review. The progress of the review will be discussed at the monthly meeting referenced in part VII, paragraph 1.

Unless otherwise agreed to by the parties, the $388,800 will be used in Areas that the study identified as being under-resourced with deaf services (e.g., Metro Boston and Central) and to address the identified need for intensive residential services (e.g., group residences, staffed apartments) in order to increase residential bed capacity.

1. DMH will establish a working group of key provider organizations to develop strategies and interventions for responding to the needs of clients who are deaf or hard of hearing. The groups to be invited to participate will include Mental Health and Substance Abuse Corporation of Massachusetts, Inc., the Clubhouse Coalition, and the Supported Education and Employment (SEE) Coalition, and Deaf Inc.

2. On or before April 30, 2004, the DMH Commissioner will recommend to the Governor, one or more persons with experience and knowledge of mental health services to people who are deaf or hard of hearing, for appointment to the DMH State Advisory Committee (SAC).

VII. Miscellaneous.

1. Beginning one month from the date of the signing of this Memorandum of Understanding, at a date and time convenient to the parties, and at monthly intervals for twelve months thereafter, representatives of the Department of Mental Health, including the Statewide Coordinator of Deaf Services and Deputy Commissioner Detrick and/or Assistant Commissioner O’Neil, will meet with representatives of the Center for Public Representation to discuss the progress of implementation of this Memorandum of Understanding. Thereafter, the parties shall meet no less frequently than once every three months, unless otherwise agreed to by the parties.

3. This Memorandum of Understanding is signed in good faith by the parties to avoid the costs and uncertainties of litigation. By entering into this Memorandum of Understanding, DMH does not admit or acknowledge that its services to eligible clients who are deaf or hard of hearing violate or have violated any provision of any state or federal constitution, law, or regulation. Neither of the parties asserts or acknowledges that the implementation of the initiatives in this Memorandum of Understanding would necessarily be sufficient to comply with the provisions of any state or federal constitution, law, or regulation.

4. If CPR believes that that DMH is in substantial breach of a term or terms of this Memorandum of Understanding, it shall notify the Commissioner of DMH in writing. The Commissioner shall respond in writing to the notification within 30 days of receipt. If the Commissioner denies there was a breach, CPR may, at its discretion, file litigation. If the Commissioner requests time to remedy the alleged breach, CPR shall not file any litigation for at least 30 days, in order to allow time for the alleged breach to be remedied.

5. This Memorandum of Understanding shall expire 24 months from the date specified below unless otherwise agreed to by the parties.