Language Access Plan Department of Mental Health...Department of Mental Health Language Access Plan...

Department of Mental HealthLanguage Access Plan

Monday, January 10, 2011

I. Introduction

The Department of Mental Health ("DMH" or "Department") has prepared this Language AccessPlan ("LAP" or "Plan"), which defines the actions to be taken by the Department to ensuremeaningful access to DMH services, programs and activities on the part of persons who havelimited English proficiency. The Department will review and update this LAP on a biannualbasis in order to ensure continued responsiveness to language assistance needs.

DMH provides person-and-family-centered services with a goal of supporting people recoveringfrom mental illness. Clear and accurate communication between clients and staff is crucial toimprove physical and mental health, rehabilitation and, above all, personal choice on the path torecovery.

II. Purpose

A Limited English Proficient ("LEP") person is someone who is not able to speak, read, write orunderstand the English language at a level that allows him/her to interact effectively with theDepartment. The Department's long-established language assistance program is guided bystatutes, regulations, and accreditation standards. (Appendix A: 104 CMR 27.03, 27.18, 28.03(1), 29.06 & 29.11.) The LAP also is consistent with the requirements of the AdministrativeBulletin #16 as promulgated by the Executive Office for Administration and Finance, and withthe United States Department of Health and Human Services guidelines for language assistanceprograms. http : //www. j ustice.gov/crt/cor/lep/bhsrevi sedl epguidance.php.

As specified by the federal regulations, the Department takes "reasonable steps to ensuremeaningful access to programs and activities by LEP persons." In accordance with theDepartment of Health and Human Services guidelines, DMH has made an individualizedassessment that balances the following four factors:

1. The number or proportion of LEP persons eligible to be served or likely to beencountered by the program or grantee;

2. The frequency with which LEP individuals come in contact with the program;3. The nature and importance of the program, activity, or service provided by the

program to people's lives; and4. The resources available to the grantee/recipient and costs.

DMH notifies contracted vendors of standards for LEP access and expects that the agency's planwill be applied to the activities they are conducting on DMH's behalf. The Department hasincorporated the language assistance requirement in service standards and vendor contracts. Inaddition, some of the Department's contracted vendors are also recipients of federal assistance,and as such will have independent obligations to comply with the Department of Health andHuman Services guidance.

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III. Agency Description

The Department, as the state's mental health authority, assures and provides access to servicesand supports to meet the mental health needs of individuals of all ages, enabling them to live,work and participate in their communities. Recognizing that mental health services are anessential part of healthcare, DMH establishes standards to ensure effective and culturally andlinguistically competent care to promote recovery. DMH sets policy, promotes self-determination, protects human rights and supports mental health training and research. Thiscritical mission is accomplished by working in partnership with other state agencies, individuals,families, providers and communities.

DMH is organized into Areas, each of which is managed by an Area Director. Each Area isdivided into Local Service Sites. Each Site provides case management and oversees anintegrated system of state and vendor-operated adult and child/adolescent mental health services.Significant planning, budget development, program monitoring, contracting, and qualityimprovement activities are conducted at Site and Area offices.

State-operated and contracted service sites, which are funded through state appropriations and afederal block grant, include state hospitals, community mental health centers with inpatient units,adult inpatient units at two public health hospitals, contracted adult, adolescent and latency ageinpatient units, latency and adolescent intensive residential treatment programs, and community-based facilities.The Office of Multicultural Affairs (OMCA) in the Commissioner's office has the structural andfunctional responsibility and accountability for developing the Department's cultural andlinguistic competence and all aspects of cultural competence in the mental health servicedelivery system for children and adults. Included in the OMCA activities is the coordination of astatewide interpreter and translation services.

The Interpreter and Translation Services Program ("ITSP") coordinates interpreter andtranslation services for all Areas, Sites, inpatient facilities, forensic functions, investigations, andhuman rights office activities. It also handles translations of DMH materials. The ITSPcoordinates translation requests, processes payment vouchers, and monitor translation usage.

Communication access for deaf and hard of hearing clients is administered through theDepartment's Deaf and Hard of Hearing Services. DMH utilizes American Sign Languages andprovides services to Deaf and Hard of Hearing as accommodations under the AmericanDisability Act. DMH has guidelines to insure cultural/linguistic access and appropriate servicesto Deaf and Hard of Hearing individuals. The Department has received technical assistance fromMassachusetts Commission for Deaf and Hard of Hearing in establishing guidelines and usingtechnology to enhance access.

The Department uses a comprehensive and integrated strategy to address the needs of culturaland linguistic populations, whether the clients speak English moderately well, very well, or notat all. The Department defines Cultural and Linguistic Competence as the integration andtransformation of knowledge, information and data about individuals and groups of people intospecific clinical standards, skills, service approaches, techniques and marketing programs that

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match the individual's culture and increase the quality and appropriateness of health care andoutcomes.

The Department's Cultural & Linguistic Competence Action Plan "operationalizes" theDepartment's mission of culturally and linguistically competent care to ensure that the mentalhealth system is attentive to the needs and effective care of culturally and linguistically diversepopulations, including at-risk immigrants and refugees.

Strategies particularly pertaining to the Department's LAP are:1. Partner with multicultural communities in the planning, development and

implementation of culturally and linguistically effective mental health services withinthe mental health system.

2. Assure strengthened access and availability of culturally and linguistically competentservices throughout the entire DMH service delivery system.

3. Integrate cultural and linguistic competence into staff training, staff development andeducational activities.

4. Use demographic information about DMH clients and applicants to inform decisionsabout policy development, clinical practice, research, program development, servicedelivery and workforce development.

5. Promote communication and information dissemination on issues related to culturaland linguistic competence.

6. Promote leadership in cultural competence and linguistic competence to reducemental health disparities

IV. Language Access Plan:

The Department has embarked on a systemic transformation of services for adults with seriousmental illness, children and adolescents with serious mental illness or serious emotionaldisturbance. Some of the components of the transformation have come to fruition through thecross-agency collaboration implementing the Children's Behavioral Health Initiative and theCommunity Based Flexible Supports procurement. The success of the transformed system alsorelies on the redesign of the Department's administrative structure and its ability to create a moreefficient agency while maintaining a strong community presence at its local sites. Theorganizational and structural change in progress works to improve communication within theDepartment, promote stronger collaboration within and across divisions, and advance the use ofdata and measures to monitor results.

The LAP goals are:• to ensure that LEP clients of DMH continue to have meaningful access to services,

programs and activities by the use of professional interpreters and linguistically andculturally diverse staff in the context of the system transformation,

• to increase quality and efficiency with measurable outcomes of the Department'slanguage assistance program in the context of the organizational and structural re-design of the Department.

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(1)The Department's Language Access CoordinatorEd K. Wang, Psy.D.Director of Multicultural Affairs25 Staniford StreetBoston, MA 02114Phone: 617-626-8137Email: [email protected]

(2)DMH Language Assistance Program Needs The loss of individual social and economic capital, despair and victimization, and poorphysical health and overall well-being often are part of the daily experience of adults withserious mental illness or children and adolescents with serious mental illness or seriousemotional disturbance. The Department considers its services to be important forenabling clients to live, work, study and participate in their communities.

To the extent possible and with available resources, all services are conducted in theclient's preferred language by staff fluent in the language or through competentinterpreters. The Department puts the highest value on the use of bilingual and biculturalstaff before the use of interpreters. When bilingual staff is not available, professionalinterpreters will be used. With current resources for interpreter and translation services,DMH has prioritized inpatient service as one of the most important services to haveinterpreters available due to the clinical severity of mental illness or emotionaldisturbance of clients in the hospitals. In-person interpretation is the modality for clientsand staff whenever deemed necessary.

DMH continues to develop its language assistance program based on census tracking,client language data tracking and points of contact between DMH Areas, Sites and DMHhospitals and the client population.

(a) Census Population Tracking and Reports

DMH collects the most recent available Census data to track specific race, ethnic andlanguage populations in Massachusetts. They include (Appendix B: DMH CensusTracking Reports):

• 2009 one-year estimate, all Massachusetts residents over the age of five speak alanguage other than English

• 2005 Massachusetts LEP Students and Major Language Groups by SchoolDistrict

• 2006-2008 American Community Survey on Race and Ethnicity inMassachusetts

DMH also collects geographic distribution by race and ethnicity by cities to match DMHAreas and Sites:

• 2006-2008 American Community Survey on race in 25 major MA cities• 2009 Massachusetts School and District Profiles by 25 major MA cities

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DMH also includes additional data sources on refugee and immigrant. They include:• 2009 DPH Refugee and Immigrant Health Program, Massachusetts Department

of Public Health. Source: USPHS Quarantine Station Notifications toMassachusetts Department of Public Health; Voluntary Resettlement Agencies(VOLAGs).

• 2009 New Refugee Arrival in Massachusetts, Office for Refugee Resettlement,Administration for Children and Familieshttp://www.acf.hhs.gov/programs/orr/data/refugee_arrival_data.htm

• 2008 Migration Policy Institute on social demographic, language and education,workforce, income and povertyhttp://www.migrationinformation.org/datahub/acscensus.cfin

• 2005 MassInc Reporthttp://www.massinc.org/—/media/Files/Mase/020Inc/Research/Full%20Report% 20PDF%20files/changing_face_report. ashx

(b)DMH Language Makeup of Client Population

DMH's interpretation service protocol is intended to ensure that LEP clients havemeaningful access to services on a client-by-client, family-by-family basis.An analysis of current data shows that the Department's implementation of interpreterand translation services has broader reach and effect than that required by ANFAdministrative Bulletin #16 (that a specific language reaches a 5% threshold of the totalcurrent client population).

According to 2009 American Community Survey, 1 Year Estimate, "Language Spoken atHome by Ability to Speak English for the Population 5 Years other than English," LEPpopulations of more than 12,000 in the Commonwealth are: Spanish, Portuguese,Chinese, French, French Creole, Italian, Russian, Vietnamese, Greek, Arabic, Polish,Khmer, Hindi, German and Korean. DMH analysis indicates that DMH clients' languageabilities and preferences are similar, except with respect to German. In addition,Department clients speak eight other languages, including Albanian, Bosnian, CapeVerdean, Farsi, Finnish, Lao, Thai and Turkish.

(c)DMH Client Data Tracking System

The Department's Mental Health Information System ("MHIS") records the number andproportion of LEP persons served by service types and Areas/Sites.

The Interpreter & Translation Services Utilization fields show the frequency ofinterpreter use by LEP clients by languages and locations. DMH includes languageassistance for LEP as one of the measures of EHS Results.

DMH LEP Race Granular Language Number of Percentage of AreaClient Data Ethnicity clients by clients by Sites

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language andservice type

language andservice type

Mental HealthInformationSystem (MHIS)

Yes Yes Yes Yes Yes Yes

InterpreterTranslationServicesUtilization

No No Yes Yes No Yes

(d) Points of Contact between DMH and Client Population

As part of the DMH new Areas configuration, Metro-Southeast, Northeast-Suburban,Central-West Areas and each Area's corresponding Sites' plan meet the geographic aswell as the diverse cultural and linguistic needs of the populations served. The Areas andtheir Sites and DMH hospitals are the points of contact between the Department and theclient population. When language assistance is needed, the points of contact will notifythe ITSP. (4) Language Service Protocol.)

(3) Language Resources Assessment:(a) DMH will use the "Differential Pay Rate" classification of the Department'semployees to identify existing staff who are linguistically and technically able to deliverservices in a language other than English. EOHHS's Human Resource staff, whichserves DMH, will provide additional guidance on the proposed use of such staff asinterpreters.

(b)Use of DMH community-based resources in meeting language access needs

The Department is committed to the use of bilingual and bicultural staff to provideservices for the LEP clients for state and vendor operated services. In some of the fundedcommunity services, the Department has developed several specialized cultural andlinguistic programs. These programs have been developed based on the critical mass ofethnic and linguistic populations in particular service areas. They provide culturally andlinguistically effective mental health care using a "cultural broker" model, increasingaccess to a full array of culturally and linguistically appropriate community supportservices. For areas that do not have these specialized programs, DMH vendors have madestrong efforts to recruit and retain bilingual and bicultural staff. The vendors also useinterpreters where bilingual staff is not available.

The Department recognizes that current resources sometimes are insufficient to fullyprovide interpreter and translation services for contracted vendor clients. One of the sixgoals of the DMH Cultural and Linguistic Competence Action Plan is to developpartnerships with multicultural communities in planning, development andimplementation of culturally and linguistically effective services. OMCA continues towork with vendors to identify community-based organizations and non-profits that may

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serve as a cost effective resource for vendors to support their language assistanceprograms and to provide a full array of community services for LEP clients. TheDepartment's 2011 Multicultural Population Resource Directory will provide informationon services, organized by specific languages, for culturally and linguistically diversepopulations across Massachusetts. OMCA will assist contracted vendors to create anLAP as a minimum standard for addressing the needs of their LEP populations.

DMH has developed an infrastructure for providers to report client-level data to theDepartment. This new method of reporting provides DMH with the capability toorganize and analyze data, and it identifies clients for review based on established criteriaor triggers. This client-level review also allows DMH to identify individuals from ethnicor linguistic and special populations, such as transition age youth, elders, veterans, andclients who are deaf and hard of hearing, so that DMH may ensure that their services areprovided in a culturally and linguistically competent and age appropriate manner and thatthey are achieving positive outcomes.

(4) Language Service Protocols:(a) Clear and accurate communication between clients and staff is crucial to improvephysical and mental health, rehabilitation and above all, personal choice on the path torecovery. In-person interpretation is mostly utilized to achieve this goal. Telephoneinterpretation is used when setting up initial service appointments, providinginformation and referrals to public and in circumstances when interpretation on demandis needed.

DMH considers mental health interpretation and translation as a highly technical skilland has discouraged the use of language volunteers to provide technical interpretationunless they have formal medical and mental health interpretation. It is the expectationof the Department to refrain using family members or friends to provide interpreterservices and no minors are allowed to provide interpretation.

(b)The Department's Interpreter and Translation Services Program (ITSP) coordinatesall state-operated services for clients and staff of the Department in need of professionalinterpreter or translator services. Where bilingual staff is not available for state operatedservices, the Department uses interpreters from the state Master Services Agreement forForeign Language Written Translation and Oral Interpretation Services.Contracted vendors are responsible for vendor-operated adult and child/adolescentmental health services to provide language assistance for their clients and staff.

The Department has developed and issued a document entitled, "Interpreter Services: AHandbook for DMH Employees," and it includes protocols and procedures for theDepartment's staff who are most likely to encounter LEP clients. The Handbook will beupdated base on this LAP. It will be available on the Department's Intranet andtraining will be conducted. OMCA also plans to update the current inventory of alltranslated DMH documents and web-links that provide translated health and mentalhealth publications on the Department's Intranet.

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(c) Persons who need DMH-funded community-based services, or providers of mentalhealth care making a referral, need to complete Service Application Forms whenapplying for mental health services for adults, children, and adolescents. Whenadditional information is needed from the applicants and/or guardians, face-to-faceinterpreters or telephonic interpretation will be provided. The Application for AdultServices is translated into Chinese, Haitian Creole, Portuguese, Spanish and theApplication for Child/Adolescent Services is translated into Haitian Creole andSpanish. Appeal Guidelines are translated into Chinese, Haitian Creole, Khmer,Spanish and Vietnamese.

The DMH Service Applications ask the applicants to self-identify their preferredlanguage for communication, even if they can speak English, and ask whetherinterpreters are needed. Applicants maintain the right to self-identify or not as an LEPperson. If the applicants are legal minors, the preferred language of parents, andwhether interpreter services are needed, are also sought. (Appendix C: ServiceApplication.)

Identification of preferred language is intended to give a client the choice of languageas well as to acknowledge that, even though a client maybe more fluent in onelanguage, s/he may prefer to use another language to communicate for a variety ofreasons. The client is encouraged to use the preferred language and the option for aninterpreter is always open when preferences change. The goal is for the client to decidewhat is the best way to communicate.

(5) Vital Document Translation:Vital documents include:

• Service Application• Release, consent, verification, and other materials necessary for service

determinations• Notification of rights and appeal guidelines• Human Rights Handbook• Legal documents pertaining to commitment and hospitalization• Facility and area specific materials• Disaster response• Individualized treatment plans and records

Due to the significant costs involved, the translation of vital documents into differentlanguages is a multi-year process. The initial focus is Spanish translations toaccommodate the largest identified LEP population in Massachusetts. The Departmenteach year identifies languages frequently encountered through its services andtranslates documents with available resources. Some of the translated documents areavailable on the Department's Internet. (Appendix D: DMH Foreign LanguageTranslation.)

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Vital documents, including individualized treatment planning, acceptance and denial ofservices, disaster response and other time sensitive documents, will be translatedimmediately. Even with the availability of translated documents, in-person interpretersare also used to assure the content of the document is clearly understood andcommunicated between clients and staff.

(6) Stakeholder Consultations:The Multicultural Advisory Committee ("MAC") of DMH supports the Department inits commitment to equitable and quality mental health care of the culturally andlinguistically diverse communities, including at-risk immigrants and refugees. Thisexternal advisory committee provides input into planning, and monitors implementationand progress of, the Department's Cultural and Linguistic Competence Action Plan.The new Action Plan will include the implementation of the LAP. MAC will reviewthe LAP and implementation outcomes.

The diverse MAC members also serve as the Department's ambassadors to its racially,ethnically and linguistically diverse communities, and they facilitate partnershipbetween the Department and community organizations and advocates in addressing thecomplex needs of underrepresented and underserved populations, including thereduction of language barriers to services.

(7) Staff Training:The approved LAP will be disseminated to all Department heads and will be availableon the Department's Intranet for all employees. "Interpreter Services: A Handbook forDMH Employees" will be revised and disseminated to all employees. A jointtraining/orientation between DMH frontline staff who are likely to have contacts withLEP populations and interpreters who are providing services will be provided. Thegoal of the training is to increase quality by focusing on the role and proper use ofinterpreters. Such training will also be extended to vendors' staff.

(8) Notice to Public: DMH regulations covering mental health inpatient facilities (104 CMR 27.00) require"written notification and a posting in the client's primary language of the right to andavailability of interpreter services." The posting, which states that, "You have the rightto an interpreter at no cost to you," is translated in 30 languages. Human RightsOfficers further reinforce the awareness and the availability of language assistance witha written notification in eight languages when they meet with the LEP clientsindividually after the clients' admission into the inpatient units. The Office of HumanRights will survey all facilities to ensure such signage is posted and writtennotifications are distributed to the clients.

DMH regulations covering community-based programs (104 CMR 28.00) require that,"A notice of the client rights as set forth in 104 CMR 28.03(1) (a) through (j)...beposted in appropriate and conspicuous places to which clients and family membershave access in the program, and available to any person upon request," that the notice

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"...be written in language that is easy to understand," and that, "...to the extentpracticable, [the notice] ...be translated into the requesting person's preferred language."

The Office of Human Rights will survey all programs to ensure that these notices ofclient rights are posted and that translations are available.

(9) DMH Monitoring:The Department's LAP goal is to improve the accessibility and quality of the languageassistance program by the use of data and measures. DMH will:

(a) review the specific language make-up of its client population in comparison tothe Massachusetts Census, identifying language groups who are not beingserved or are under-served,

The total number and proportion of LEP clients served by DMH and each service incomparison to American Community Survey on language ability indicating thatindividuals speak English "less than very well"

Language AmericanCommunity Survey

DMHClient Preferred

DMHPreferred Language

"speak English less Language and and Interpreter Neededthan very well" Interpreter Needed by Service Type

(b)continue to collect and analyze data for one of the Department's EHS indicators,the percentage of requests fulfilled for interpreter services for DMH state-operated services,

(c) continue to collect 2009 Consumer and Family Member Satisfaction Surveyitems on whether LEP clients of adult community and inpatient services andfamilies of children/adolescents received language assistance,

(d) conduct a client-level performance review by the Department's contractmonitoring teams of CBFS services delivered, including the frequency andduration of interpreters used by LEP clients,

(e) identify and implement solutions to any issues related to serving LEP personsthat may have emerged during the year or any significant changes in thelanguage needs of the service population.

(10) Complaints:A client or client representative may file a complaint with either the Language AccessCoordinator or the Office of Access and Opportunity.

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Language Access Complaint Procedure (additional procedures will be developed byANF):

You may file a complaint with the Agency Language Access Coordinator or the Officeof Access and Opportunity if you believe you have been denied the benefits of thisPlan. You must file your complaint within 6 months of the alleged denial. You mustfile a written complaint. To file a complaint with the Language Access Coordinator,submit the written complaint to:

Name of Language Access Coordinator:

Ed K.S. Wang, Psy.D.Massachusetts Department of Mental Health25 Staniford St.Boston, MA [email protected]

To file a complaint with the Office of Access and Opportunity, please submit thewritten complaint to the attention of:

Office of Access and OpportunityExecutive Office of Administration and FinanceState House, Room 373Boston, MA 02133Email Address: [email protected]

January 6, 2011Barbara A. Leadholm, M.S., M.B.ACommissionerDepartment of Mental Health

Date

UAIVAJudeBigbSeer aryExecutive Office of Health and Human Services

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Appendix ARegulations

104 CMR 27.00: LICENSING AND OPERATIONAL STANDARDS FOR MENTALHEALTH FACILITIES

27.03 Licensing, Generallythe Department shall conduct annual inspections of facilities granted deemed status to determinetheir compliance with Department regulations governing restraint and seclusion, human rights,investigation of complaints, and interpreter services.

27.18: Interpreter Services(1) For the purposes of 104 CMR 27.18, the following words shall have the followingmeanings:

(a)Competent Interpreter Services means interpreter services performed by a person whois fluent in English and in the language of a non-English speaker, who is trained andproficient in the skill and ethics of interpreting and who is knowledgeable about thespecialized terms and concepts that need to be interpreted for purposes of receiving careand treatment.(b) Facility shall mean a Department-operated hospital, community mental health centerwith inpatient unit, or psychiatric unit within a public health hospital; a Department-licensed psychiatric hospital; or a Department-licensed psychiatric unit within a generalhospital.(c) Non-English Speaker means a person who cannot speak or understand, or hasdifficulty speaking or understanding, English because the speaker primarily or only usesa spoken language other than English.

(2) Each facility shall in connection with the delivery of inpatient services, if an appropriatebilingual clinician is not available, provide competent interpreter services to every non-Englishspeaker who is a patient.(3) Based on the volume and diversity of non-English-speaking patients served by the facility,the facility shall use reasonable judgment as to whether to employ, or to contract for, the on-calluse of one or more interpreters for particular languages when needed, or to use competenttelephonic or televiewing interpreter services; provided that such facility shall only usecompetent telephonic or televiewing interpreter services in situations where either:

(a) there is no reasonable way to anticipate the need for employed or contractedinterpreters for a particular language; or(b)there occurs, in a particular instance, an inability to provide competent services by anemployed or contracted interpreter.

(4) Interpreter services shall be available 24 hours a day and seven days a week.(5) The facility shall not require, suggest, or encourage the use of family members or friends ofpatients as interpreters and shall not, except in exceptional circumstances, use minor children asinterpreters.(6) The facility shall post signs and provide written notification of the right to and availabilityof interpreter services to patients in their primary language.(7) The facility shall develop written policies and procedures that are consistent with 104 CMR

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27.18 and that assist staff and patients in accessing interpreter services.104 CMR 28.00: LICENSING AND OPERATIONAL STANDARDS FOR COMMUNITYPROGRAMS

A notice of the client rights as set forth in 104 CMR 28.03(1)(a) through (j) shall be postedin appropriate and conspicuous places to which clients and family members have access in theprogram, and available to any person upon request. The notice shall be written in language thatis easy to understand and, to the extent practicable, shall be translated into the requestingperson's preferred language.

104 CMR Section 29.06: General Provisions for all DMH Services Planning ActivitiesPlanning activities incorporate strengths, preferences and needs of clients, and whereappropriate, of their families or caretakers, and include assessments and the development andreview of individual service plans and individualized action plans. Clients who receive CaseManagement will have individual service plans developed in accordance 104 CMR 29.06 and29.07. Clients who receive DMH community services will have individualized action plansdeveloped in accordance with 104 CMR 29.06 and 29.11.(1) DMH Services planning activities are:

(a)conducted in the client's preferred language by staff fluent in the language or throughcompetent interpreters;(b)strength-based, person and when appropriate, family, centered;(c)sensitive and responsive to a client's cultural, ethnic, linguistic background, sexualorientation, gender differences, parental status, and other individual needs of the client;(d)based on the results of assessments which are reviewed and modified as the client'sneeds or circumstances change; and(e) informed by information obtained through interactions with the client, whenappropriate the client's family or caretakers, and the client's other service providers withthe appropriate authorizations, as well as previous records as available.

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Appendix BDMH Census Tracking Reports

Massachusetts : Language Spoken at Home by Ability to Speak English for the Population 5 Years and Over2009 American Community Survey 1- Year Estimates (DMH/OMCA 11/2010)

SpeakEnglish

only

SpeakEnglish"verywell" %

SpeakEnglish lessthan "very

well" % Total %English 4,926,679 4,926,679 79.30Spanish 245,572 4 203,601 3.30 449,173 7.20Portuguese 96,526 1.50 93,869 1.50 190,395 3Chinese 46,929 0.75 49,093 0.79 96,022 1.50French 53,456 0.86 13,372 0.21 66,828 1.10French Creole 30,043 0.48 21,489 0.35 51,532 0.83Italian 31,081 0.50 10,772 0.17 41,853 0.70Russian 20,904 0.34 20,126 0.32 41,030 0.70Vietnamese 12,736 0.20 23,443 0.38 36,179 0.60Greek 18,025 0.30 7,691 0.12 25,716 0.40Arabic 14,386 0.23 10,515 0.17 24,901 0.40Polish 16,326 0.26 5,749 0.10 22,075 0.35Khmer 8,707 0.14 11,504 0.18 20,211 0.32Hindi 13,598 0.22 2,567 0.04 16,165 0.26German 13,707 0.22 2,288 0.04 15,995 0.26Korean 5,980 0.10 6,287 0.10 12,267 0.20Tagalog 7,168 0.11 2,898 0.05 10,057 0.16Hebrew 8,507 0.14 677 0.01 9,184 0.15Japanese 5,123 0.08 3,520 0.06 8,643 0.14Gujarathi 4,735 0.08 3,126 0.05 7,861 0.13Amenian 4,503 0.07 1,599 0.03 6,102 0.10Persian 4,317 0.07 1,336 0.02 5,653 0.09Languages other thanEnglish Combined 124,164 2Total 6,208,685

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Ethnic Groups in Massachusetts**Based on American Community Survey 2006-2008 Estimates

Afghan 579 Kenyan 3,269African American 0 Korean 21,023Albanian 13,532 Laotian 3,515American 216,916 Latvian 3,190Arab 4,060 Lebanese 23,245Argentinean 3,562 Liberian 1,388Armenian 21,395 Lithuanian 30,860Asian Indian 63,449 Mexican 37,575Austrian 8,953 Moldovian 0Belgian 2,684 Moroccan 6,958Bhutanese 0 Myanmar/Burmese 0Brazilian 63,620 Nigerian 6,253British 24,599 Norwegian 20,729Bulgarian 2,874 Other 0Cambodian 22,144 Other - African 0Canadian 39,929 Other - Asian 0Cape Verdean 49,570 Other - Caribbean 0Chilean 3,346 Other - European 0Chinese 112,019 Other - Latin America 0Chooses not to self-identify 0 Pakistani 3,141Colombian 23,237 Panamanian 2,674Costa Rican 3,602 Peruvian 7,029Cuban 8,859 Polish 221,066Czech 10,071 Portuguese 252,171Danish 8,156 Puerto Rican 234,375Dominican 89,430 Romanian 5,158Dutch 23,003 Russian 91,251Ecuadorian 5,198 Salvadoran 33,925Egyptian 4,305 Sandinavian 5,560English 463,342 Scottish 102,941Ethiopian 3,462 Scottish Irish 87,083Filipino 13,229 Sierra Leonean 841

Ethnic Groups in Massachusetts continuedFinnish 17,859 Somalian 2,693French 343,395 Sudanese 249French Canadian 203,686 Swedish 69,730German 234,763 Swiss 7,277Ghanian 2,838 Syrian 4,062Greek 70,717 Thai 3,279Guatemalan 29,102 Turkish 5,321Haitian 58,417 Ugandan 1,453Hmong 629 Ukrainian 16,336Honduran 13,567 Venezuelan 2,943Hungarian 12,097 Vietnamese 42,615

of 25



Indonesian 1,257 Welsh 12,247Iranian 7,179 West Indian 7,079Iraqi 132Irish 1,107,287Israeli 4,194Italian 685,898Jamaican 20,092Japanese 9,036 DMH/OMCA 2/2010

of 25

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Appendix CService Application (page 4) & DMH Language Table

Commonwealth of Massachusetts Department of Mental Health (DMH)

REQUEST FOR ADULT SERVICES

Effective October 2009

Personal Information

Name S SN (Last) (First)

(Middle)

(Social Security Number)

Address(Number and Street)

(Apt No)

(City) (State)

(Zip Code)

How may we contact you? (Please check all that apply and provide phone number/e-mail address)

q Day/Work Phone

q Evening Phone

q Cell Phone

q e-mail

May we leave a message? Yes q No q

May we leave a message? Yes q No qMay we leave a message? Yes q No q

Birth Date / / Age Gender RaceMM /DD/YYYY

Preferred Language

Are you deaf or hard of hearing? Yes 11] No 111

Ethnicity Marital Status (Optional) (Optional)

Do you speak English? Yes q

Do you need interpreter services? Y q El

Have you ever served in the military? Yes q No 111 Unknown nDo you have a court appointed legal guardian? Yes q No E If yes, what type?

If yes, please submit a copy of the guardianship decree with this application. The legal guardian must sign the application and all the releases of information for theapplication to be processed.

Name of Legal Guardian Relationship (Last) (Fiist) (Relationship to Applicant)

Guardian's address (Number and Street) (Apt No) (City) (State) (Zip Code)

How may we contact the guardian? (Please check all that apply and provide phone number/e-mail address)

CC

Day/Work Phone

Evening Phone

Cell Phone

Email



May we leave a message? Yes q No 11]

May we send a message? Yes q No q

Name of Emergency Contact Phone #

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(Last) (First)Please Include a Release of Information

Health InsuranceNo health insurance qApplication for Health Insurance Pending q Please specify insurance:

Medicaid q If Medicaid and under 21, is applicant currently enrolled in CSA? q Please identify:

Medicare/MedicaidMedicarePrivate Insurance: q Please specify insurance:

Source of Income

Employment q Family q

SSDI q Emergency Aid ESSI q Other E Please specify:Social qSecurity q No Income

If you are a parent or step parent, are there children living in the home? Yes q No q Not Applicable q

,kre you currently involved with another state agency? Yes E No q Unknown q

If yes, which DCF DDS EOEA DPH DYS MRC MCDHH MCB VAagency?

C u Cl Check all thatapply.

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DMH Client Preferred Language Table

DMH Client Preferred Language TableALBANIAN SPANISHAMERICAN SIGN LANGUAGE TAGALOG/FILIPINOAMHARIC TAMILARABIC THAIARMENIAN TIGRIGNABOSNIAN TURKISHCAPE VERDEAN URDISHCHINESE VIETNAMESEENGLISH YIDDISHFARSI/IRANIAN/PERSIANFINNISHFRENCHGERMANGREEKHAITIAN CREOLEHEBREWHINDIIBOITALIANJAPANESEKHMER/CAMBODIANKOREANLAOOTHERPOLISHPORTUGUESERUSSIANSERBIAN-CROATIANSOMALI

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Appendix DForeign Language Translations

August 2010

DMH Service ApplicationsAdult Application 2009 Chinese, Haitian, Portuguese,

SpanishChild/Adolescent Application 2009 Haitian, SpanishAppeal Guidelines for Denial of Eligibility Based on 2008 SpanishClinical CriteriaAppeal Guidelines: Denial of Eligibility Based on Need 2008 Chinese, Haitian, Khmer, Spanish,for DMH Continuing Care Services VietnameseClinical ToolsCERF 2005 Portuguese, SpanishCERF-R 2005 Portuguese, SpanishLegal Documents — Consent FormsConsent Form for Psychiatric Treatment (Pursuant to 1996 Chinese, Portuguese, Spanish,DMH Policy #96-3) VietnameseLegal Documents — Commitment FormsForm CV-300 2005 Chinese, Haitian, Khmer,Application For Care And Treatment On A Conditional Portuguese, Spanish, VietnameseVoluntary BasisM.G.L. Chapter 123, Sections 10 & 11Form CV-300G 2005 Chinese, Khmer, Portuguese (partApplication For Care And Treatment On A Conditional 1), Portuguese (part 2), Spanish,Voluntary Basis VietnameseM.G.L. Chapter 123, Sections 10 & 11(made by Guardian With Authority to Admit)Form 301 2005 Chinese, Khmer, Portuguese,NOTICE OF RIGHTS Spanish, VietnameseTo be given to all patients 16 years of age and olderForm CV-301G 2005 Chinese, Haitian, Khmer,NOTICE OF RIGHTS Portuguese, Spanish, Vietnamese(Parent of a Minor or Guardian With Authority to Admit)Form 12(b)-302 2005 Chinese, Haitian, Khmer,NOTICE OF RIGHTS Portuguese, Spanish, VietnameseTo be given to all patients admitted under M.G.L. c. 123,s. 12 (b)Form 12(b)-302G 2005 Chinese, Haitian, Khmer,NOTICE OF RIGHTS Portuguese, Spanish, Vietnamese(Parent of a Minor Under Sixteen or Guardian)Temporary Involuntary HospitalizationM.G.L. Chapter 123, Section 12 (b)Form NT-3 2005 Chinese, Haitian, Khmer,NOTIFICATION OF TRANSFER Portuguese, Spanish, VietnameseM.G.L. Chapter 123, Section 3Legal Documents — HIPAAAuthorization for Release of Information (Two-Way) 4/03 Arabic, Chinese, Haitian, Khmer,

of 25



Portuguese, Russian, Spanish,Vietnamese

Notice of Privacy Practices, Version 6 (brochure) 10/2010

Arabic, Chinese, Haitian, Khmer,Portuguese, Russian, Spanish,Vietnamese

Notice of Privacy Practices, Version 5 TO- a e 9/09 Arabic, Chinese, Haitian, Khmer,Portuguese, Russian, Spanish,Vietnamese

Notice of Privacy Practices brochure, Version 4 1/05 Arabic, Chinese, Haitian, Khmer,Portuguese, Russian, Spanish,Vietnamese

Legal Documents - OtherReport of Monitor SpanishMedication ManualsDMH Medication Information Manual 2008 Haitian, Portuguese, SpanishPsychoactive Medication for Children and Adolescents: 2007 SpanishOrientation for Parents, Guardians, and OthersAbilify (aripiprazole) — Information Sheet PortugueseHuman RightsYour Five Fundamental Rights — Brief Overview Chinese, Haitian, Portuguese,

Spanish, VietnameseDMH Human Rights Handbook 2005 SpanishYour Rights — Child/Adolescent Services brochure 2010 Arabic, Cape Verdean, Chinese,

Haitian, Khmer, Portuguese,Russian, Spanish, Vietnamese

Standards and Rights in a DMH Adult Community 2004 Arabic, Chinese, Haitian, Khmer,Program Portuguese, Russian, Spanish,

VietnameseInterpreter Rights, MGL, Chapter 123, Section 23A: 104 Arabic, Chinese, Haitian, Khmer,CMR 27.18 Portuguese, Russian, Spanish,"You have the right to an interpreter at no cost to you." Vietnamese(Hand-out explaining Interpreter Law)30 Language Poster: Albanian, Amharic, Arabic,Interpreter Services — You have the right to an interpreter Armenian, Bengali, Cape Verdeanat no cost to you. Creole, Chinese, French, German,

Greek, Haitian, Hebrew, Hindi,Hmong, Italian, Japanese, Khmer,Korean, Laotian, Polish,Portuguese, Russian, Serbo-Croatian, Somali, Spanish, Swahili,Tagalog, Thai, Urdu, Vietnamese

Facility-Specific/Area-SpecificPatient Rights and Responsibilities Handbook — Dr.Solomon Carter Fuller Mental Health Center AdultInpatient Unit

2009 Chinese, Spanish

Patient/Family Orientation Guide to the Dr. SolomonCarter Fuller Mental Health Center Adult Inpatient Unit

2009 Chinese, Spanish

Your Guide to Adult Mental Health Services in Western 2009 Khmer, Spanish

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Massachusetts (brochure)Your Guide to Child/Adolescent Mental Health Servicesin Western Massachusetts (brochure)

2009 Khmer, Spanish

Metro Boston Mental Health Units at Lemuel ShattuckHospital — Patient Handbook

2008 Chinese, Haitian, Portuguese,Russian, Spanish, Vietnamese

10 North Unit Guidelines (Shattuck) 2007 French, SpanishYour Rights as a Patient at Dr. Solomon Carter FullerMental Health Center — Your Legal Status as a Patient

Spanish

Taunton State Hospital Patient & Family Handbook 2004 PortugueseTewksbury Hospital — Fire & Safety Class SpanishCBFSCBFS Factsheet 2009 SpanishCBFS FAQs 2009 SpanishCBFS (Powerpoint) 2009 SpanishDisaster ResponseMass. State Disaster Behavioral Health Services 2010 French, Haitian(brochure)American Red Cross (fact sheet) 2010 French, HaitianKatrina flyer 2005 Chinese, Haitian, Khmer, Spanish,

VietnameseResourcesNAMI Brochure 2010 Haitian, Portuguese, Russian,

VietnameseOMCA Brochure 2010 Arabic, Cape Verdean, Chinese,

Haitian, Khmer, Portuguese,Russian, Spanish, Vietnamese

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Language Access Plan Department of Mental Health...Department of Mental Health Language Access Plan...

Documents

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