TO:    All Organizational Components

SUBJECT:   Culturally and Liguistically Appropriate Services to Consumers who have Limited English Proficiency (LEP), or are Hard of Hearing or Deaf.

I.   PURPOSE: 
The purpose of this Directive is to ensure each Facility and Community Mental Health Center has a policy and procedure to provide culturally and linguistically appropriate services to its consumers who are not proficient in the English language, to the extent that they cannot access the services or programs offered by the agency without language assistance.

II.  POLICY:
It is the policy of the Department of Mental Health (DMH) to recognize and respect the cultural diversity of its consumers and to provide culturally and linguistically appropriate services to all of its consumers. Moreover, it is the policy of the Department to provide services to those needing them without regard to national origin or disabilities. Included are individuals who have limited English proficiency, or are hard-of-hearing or deaf. The Department recognizes that in order to provide meaningful access to its behavioral health services to consumers who have limited English proficiency, or are hard-of- hearing or deaf, DMH facilities and community mental health centers must have procedures in place to provide communication services, including interpreter services at no cost to the consumer. Accurate and adequate communication between consumers and providers is a necessary element for providing good quality care, and it is a recognized right of consumers. The treatment staff needs to have the capability to effectively communicate with and relate to the experiences of consumers from diverse cultures, as this is an important component of culturally competent treatment.

III. PROCEDURES:

Every facility and community mental health center will develop a written Policy and Procedure to provide meaningful access to culturally and linguistically appropriate services to consumers who have Limited English Proficiency (LEP), or are hard-of- hearing or deaf. Such Policy and Procedure will be submitted to the SC DMH State Director for approval within 90 days of this Directive being in effect, and shall include, but not be limited to, the following provisions:

A. Definitions:

1. The term Culturally and Linguistically Appropriate Services refers to the range of services that are respectful of and responsive to the cultural and linguistic needs of the consumers.

2. The term Limited English Proficiency (LEP) refers to the lack of proficiency in the English language to the extent that consumers cannot access the services or programs offered by the agency without language assistance.

3. The term Communicator refers to facility or center staff and volunteers who are capable of communicating with certain consumers, who have Limited English proficiency, or are hard-of-hearing or deaf. Individuals identified as "communicators" are listed in the SC DMH Bicultural/Bilingual Staff List. Their level of proficiency will be determined according to the American Council on the Teaching of Foreign Languages (ACTFL) Proficiency Guidelines-Speaking, Revised 1999 (See Appendix A).

It is essential that every facility and community mental health center understand that Communicators do not have specialized training in the issues related to providing professional interpreter services and some may lack the ability to understand or interpret certain concepts, official or medical terminology and may not possess the necessary language and comprehension skills. Therefore, in seeking their assistance, providers need to ensure that their selection will be based on the task, their indicated level of fluency and training.

4. The term Interpreter refers to individuals who are qualified, or certified by a recognized professional organization as being skilled and proficient in providing interpreter services, and who follow a professional code of ethics, which govern such issues as accuracy, neutrality and confidentiality. Examples of organizations are the Registry of Interpreters for the Deaf (RID) and the Carolina Association of Translators and Interpreters (CAT!).

5. The term vital documents refer to those documents containing information that is required by law or critical for the access of services, Notice of Privacy Practices, rights and benefits. For example, applications, consent forms, letters and notices pertaining to the reduction, denial or termination of services or benefits and letters or notices that require a response of the beneficiary or consumer.

B. Designation of Staff:

The policy and procedure will provide a process whereby the facility or center director designates one or more staff members who shall be responsible for ensuring that the facility or center's services are accessible to consumers who have limited English proficiency.

C. Role of Designated Staff:

The policy and procedure will describe the responsibility of designated staff in ensuring access to services by consumers who have limited English proficiency.

D. Measures to ensure meaningful access to services:

The policy and procedure will describe the measures to be implemented to ensure access and should at least include the following activities:

1. Conducting a thorough assessment of the Centers and Facilities need for interpreter services. This can be done by identifying the non-English languages that are likely to be encountered as well as the language needs of consumers who have LEP. It is also important to identify points of contact, the amount, location and availability of interpreter services and arrangements that must be made to access these resources in a timely manner.

2. Ensuring that information about the consumer is collected at the onset of treatment, and is included in the consumer's medical record. This information includes, at the minimum, the consumer's race, ethnicity, degree of fluency in English and language of preference.

3. Maintaining a current demographic, cultural and epidemiological profile of the community in order to plan services to meet the needs of these populations.

4. Arranging for appropriate language assistance services. or oral interpretation, depending on the center or facility capability. This might include procedures for utilizing contract interpreters, staff interpreters, identifying and providing interpreter training for bilingual and American Sign Language (ASL) proficient staff, recruitment of bilingual and ASL proficient staff, telephone interpreter lines and other communications assistive technology.

5. Monitoring and reporting annually to the SC DMH Director of Cultural Competence, the suitability and efficacy of their efforts and success of the implementation of culturally and linguistically appropriate services. For example, current population in the catchment area who has LEP, communication needs of consumers attending the Programs who have LEP, ability of the Facility or Center to meet the needs of these consumers, availability of language assistance in the catchment area and ongoing efforts to keep staff informed about the LEP policy and procedures.

6. Providing notice to consumers who have Limited English Proficiency "regarding their right to language assistance and the availability of such assistance free of charge." Facilities and Centers may use the following methods proposed by the Office for Civil Rights of the Department of Health and Human Services:

a. Use of language identification cards, which allow consumers who have LEP to identify their language needs to staff and for staff to identify the language needs of applicants and consumers. To be effective, the cards (e.g., "I speak cards") must invite the consumers who have LEP to identify the language they speak. This identification must be recorded in their medical record (See Appendix B).

b. Posting and maintaining signs in regularly encountered languages, other than English, in the waiting rooms, reception areas and other initial points of entry .In order to be effective, these signs must inform consumers of their right to free language assistance services and invite them to identify themselves as persons needing such services.

c. Translation of forms and instructional, informational and other written materials into appropriate non-English languages by competent translators, in conformance with the guidelines set by the Department of Justice as follows:

cl. Written materials, routinely provided in English to the consumers, including vital documents are translated for each eligible LEP language group that constitutes ten (10) percent or 3,000, whichever is less, of the population eligible to be served or likely to be directly affected by the recipient/covered entity's programs;

c2. Vital documents are translated for each eligible LEP language group that constitutes five (5) percent or 1,000; whichever is less of the population eligible to be served or likely to be directly affected by the recipient/covered entity's programs. Translation of other documents, if needed, is provided orally.

C3. Notwithstanding the above, for each language group "with fewer than So persons that reaches the five percent trigger" in C2, "the recipient does not translate vital written materials but provides written notice of the right to receive competent oral translation of written materials, free of cost, in the primary language of that language group" (DOJ, 2002)

These expectations will be applied according to the population in the catchment areas of the Facilities, Community Mental Health Centers and their clinics

d. Uniform procedures for timely and effective telephone communication between staff and consumers who have LEP. This must include instructions for English-speaking employees to obtain assistance from interpreters or bilingual staff when receiving calls from or initiating calls to consumers who have LEP; and

e. Inclusion of statements about the services available and the right to free language assistance services, in appropriate non-English languages, in brochures, booklets, outreach and recruitment information and other materials that are routinely disseminated to the public.

7. Providing Interpreter Services

The policy and procedure will specify the measures to be taken to provide for accurate and adequate communication with the consumers of the hospital or Center who are not proficient in English or are hard-of-hearing or deaf, to the extent that they cannot access the services or programs offered by the agency without language assistance, including :

7a. Use of Interpreter during the treatment process, to include intake, initial evaluation, any examinations by examiners designated by a probate judge (if examination is conducted by DMH staff) and treatment interventions such as treatment planning, medical/psychiatric assessments, counseling sessions.

7b. Use of a Communicator only when an Interpreter is not available and after making unsuccessful bonafide attempts to secure one. When this happens, the clinician will document the justification for the use of a communicator in place of an interpreter in the consumer's medical record.

7c. In the case when the consumer insists in the use of a family member or friend to do the interpretation, after being informed of the availability of free language assistance, the provider will:

7cl. Explain that having a qualified interpreter or communicator is in the best interest of the consumer and the family, and will welcome the family member to be involved as a support to the consumer.

7c2. Document the consumer's decision to use or not use the agency interpreter or communicator in the medical record.

7c3. Consider having a qualified interpreter or communicator present during the session to assure the accuracy and effectiveness of the communication. The participation of family members as interpreters or communicators may result in breach of confidentiality; it may also limit or cause erroneous translation of specialized concepts due to their possible limited knowledge of medical/psychological terminology and/or limited proficiency in the English language.

7d. When consumers who have LEP, or are hard-of-hearing or deaf, are the subject of an involuntary commitment proceeding, the policy will ensure the appropriate probate judge is notified of the need for an Interpreter in advance of the hearing. It is the responsibility of the Court to provide interpreter services during the hearing.

7e. The maintenance of confidentiality when providing treatment services to consumers who have LEP or are hard-of-hearing or deaf. Interpreters, who are not DMH staff or volunteers, will be provided with a copy of the Department's Directive concerning the privacy of medical records and patient information, and must sign the receipt form, which acknowledges their receipt of the Directive.

8. Informing/Training of all staff:

The policy and procedure will provide for means of informing or training all staff of the facility or center about the procedures to follow to obtain communication services when needed. This training should occur at the onset of employment and periodically thereafter, to maintain the staff that has contact with consumers who have LEP knowledgeable and aware of changes in the policy and procedure.

This Directive rescinds and supersedes SCDMH Directive No. 657-84, "Interpreter Services."