VR Staff Training – Area 4 Effective Delivery of VR Services to Individuals with Hearing Loss

1. VR Staff Training – Area 4Effective Delivery of VR Services to Individuals with Hearing Loss

2. Presenters Cecil Bradley - VR Administrator, DVR Stefanie Fenton, VR Staff Interpreter DVR Area 1 (Tallahassee) Valerie Stafford-Mallis – Florida Coordinating Council for the Deaf and Hard of Hearing - Department of Health

3. Content of Today’s Program Deaf & Hard of Hearing Population Descriptions of hearing loss Signs and symptoms Emotional needs Interventions Communication modifications Assistive technology Interpretive services

4. Content of Today’s Program (cont’d) Best Practices Purpose of DHH Services Program Interpreting Services Update Hearing Aids Update Prior Approvals Counseling and Guidance Individuals who are Deaf-Blind and DBS Resources + Questions and Answers Vendors and Demonstration of Devices

5. Learning Objectives We will learn to: • Recognize 4 types of individuals with hearing loss • Recognize the physical & emotional manifestations of hearing loss • Utilize Best Practices in serving this population • Understand communication accessibility • Select appropriate assistive technology & services • Utilize available community resources

6. What We Hear

7. Unique Aspects of Hearing Loss Tinnitus Distorted Hearing Hearing things that aren’t there Feelings of fullness Dizziness & vertigo Loss of balance Central auditory processing disorder Otitis media & Otitis externa

8. Hearing Loss Descriptors Deaf Hard of Hearing Late Deafened Deaf-Blind

9. Types of Hearing Loss Conductive Hearing Loss Sensori-neural Hearing Loss (aka Neural Hearing Loss) Mixed Hearing Loss

10. Levels of Hearing Loss Mild Moderate Severe Profound

11. Audiogram Examples

12. The Speech Banana

13. Working with Individuals who are Deaf Sense of hearing is non-functional without the use of technological assists May be congenital or acquired deaf vs. Deaf

14. Working with Individuals who are Deaf The Big “D” = Deaf Culture Deaf Pride Common Identity American Sign Language Recognition & Acceptance

15. Working with Individuals who are Hard of Hearing Hearing Loss can range from: Mild – Moderate – Severe – Profound Can affect one or both ears Onset is usually gradual but can be rapid

16. Working with Individuals who are Late-Deafened Hearing Loss usually severe to profound Occurs after speech and language are fully formed

17. Working with Individuals who are Deaf-Blind Defined as substantial loss of hearing and vision Does not have to mean total loss of hearing & vision May necessitate a Support Services Provider (SSP) It’s important to know the degree of residual vision and hearing to determine the appropriate type of visual, auditory, or tactile communications methods.

18. Impact of Hearing Loss on the Customer Such Impact Can Be Gradual or Sudden! Emotional Aspects Physical Aspects Relationships

19. Emotions Common to Individuals who are Late-Deafened or Hard of Hearing Five Stages of Grief 1. Shock and Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

20. Hearing Loss is Linked to: • irritability, negativism and anger • fatigue, tension, stress and depression • withdrawal from family and social situations • social rejection and loneliness • reduced alertness and increased risk to personal safety • impaired memory & the ability to learn new tasks • reduced task performance & independence • diminished psychological and overall health

21. Communicating with Individuals who are Deaf or Hard of Hearing Sensitivity Courtesy Common sense Shared responsibility between speaker & listener Don’t be afraid to ask Whatever works!

22. Communicating with Individuals who are Deaf or Hard of Hearing Attention Noisy background Light Visual Obstacles & Foreign Objects Diction and Speech: Pace & Volume

23. Communicating with Individuals who are Deaf or Hard of Hearing • Facial expressions and gestures • Conversational transition cues • Rephrase instead of repeating • Talk TO the Individual, not ABOUT him or her. • When in doubt, ASK • Be patient, positive, and relax

24. Communicating with a Signer Get their attention first Gentle tap on the shoulder, wave, or flash light only once Communicating with the Individual Use paper and pen while waiting for the interpreter to show up Use open-ended questions to probe for understanding.

25. Communicating with a Signer • Always use interpreter for informed consent • When the interpreter is present, talk directly to the individual who is deaf, not the interpreter. • Don’t talk about the individual in their presence • Don’t say “Ask him/her” or “Tell him/her” • Maintain eye contact. It is considered rude to carry on a conversation without eye contact.

26. Communicating with an Individual who is Deaf-Blind (DB) • Notify the agency/interpreter that the individual is DB • Advise agency which mode of communication is needed (visual sign language or tactile sign language) • To walk with an individual who is DB, offer an elbow and your forearm. Never push or pull them along. • Do not leave individual who is DB alone in an open space. • Escort them to a safe place and let them know why you are doing this.

27. Assistive Devices Alarm clocks Timers and watches Door signalers Phone/strobe signalers Paging systems Weather Alert systems Visual/auditory/tactile alerts • (Picture from Library Services for the Deaf and HH Website: www.tndeaflibrary.nashville.gov)

28. Assistive Listening Devices Pocket sized personal amplifiers TV Listening systems FM Systems Loop Systems Various Accessories

29. Communication Devices TTY Cell Phones Text/Tablets Amplifier/Clarity/ Cap-Tel/Caption Call

30. Personal FM System: See the Differences

31. One-on-One Text Communication http://www.youtube.com/watch?v=292Y2NTyKZY&feature=youtube_gdata_player

32. Videophone and Video Relay Service

33. Telecommunications Deaf & Hearing Connection of Tampa Bay Free Telecommunications Equipment for eligible Floridians TTY + Amplifiers/Clarity/Cap-Tel Phones Florida Relay Servicewww.ftri.org

34. DVR Deaf & Hard of Hearing Services Role of DHHS at the State Office Field & HQ Consultations and Staff Training Best Practices and CI/BAHA Prior Approvals Hearing Aid MSUP Counselor & Staff Interpreter as a Working Team Guidance from Rehabilitation Act of 1973/504, ADA Unique Services: Interpreting & Hearing Technology www.Rehabworks.org Webpage, VRI-Net

35. VR Individual with Hearing Loss Served (2010-2011) ServedPlaced (26) Hard of Hearing 2,788 406 Deaf 2,016 174 Hearing & Visual* 21 4 Deaf-Blind* 120 Total 4,837 584 *Both Combined - Classified as Deaf-Blind Per RSA 911 Coding (33/4)

36. Buying a Hearing Aid: A Refresher • First obtain Hearing Evaluation Report (Audiogram) & Recommendation from Qualified Audiologists • Compare vendor’s price with Manufacturer’s Suggested Unit Price (MSUP) on VR Intranet • Discuss with the Individual • Customer Vendor Choice for Hearing Aid Fitting: Audiologist or Hearing Aid Specialist • Difference between Audiologist & Hearing Aid Specialist

37. Best Practices: Hearing Aid Issues Hearing Loss vs. Vocational Impediments Hearing Aid Prices, Fees, & Warranty Hearing Aid Choices What about a Tele-coil? How often & how many Hearing Aids can VR buy? (Picture from Disability Graphics Website: www.lareau.org)

38. Best Practices: Cochlear Implant/BAHA Cochlear Implant and BAHA Checklist What Requires State Office Prior Approval? What about Replacements or Repairs? VR Intranet: Best Practices & FAQ

39. Best Practices: Meeting the Customer Available Accommodations Interpreting Services Communication Devices Computer Access Real-Time Captioning (CART) (Picture from www.ccacaptioning.org)

40. Best Practices: Meeting the Individual for the First Time Acknowledging Differences Communication Etiquette

41. Best Practices: Working with the Individual Good and Clear Communication Importance of Counseling & Guidance Focus: Individual’s Daily & Work Impediments Hearing Aid is not the only Service Case Notes

42. Best Practices: Functional Capacities Mobility Communication Self-Care Self-Direction Interpersonal Skill Work Tolerance Work Skills

43. Best Practices: Working with the Individual Case Notes: What to document? Counseling & Guidance Method of Communication Customer Preferences: Auxiliary Aids & Services

44. Best Practices: What to Ask the Individual • Hearing Loss History & Diagnosis • Is the Individual Wearing Hearing Aid(s)? • How old did the Individual Start Wearing One? • How the Individual Adapts to Hearing Loss? • How Communicate? Phone? Assistive Devices?

45. Best Practices: What to Ask the Individual • If Working, What Does the Individual Do? • Are there any Impediments on the Job? • Any other Barriers? In the Environment? With People? • Are Accommodations Provided on the Job? • What Does the Individual Need from VR?

46. THE HEARING HANDICAP INVENTORY - SCREENING FORM 1. Does a hearing problem cause you to feel embarrassed when you meet new people? 2. Does a hearing problem cause you to feel frustrated when talking to members of your family? 3. Do you have difficulty when someone speaks in a whisper? 4. Do you feel handicapped by a hearing problem? 5. Does a hearing problem cause you difficulty when visiting friends, relatives, or neighbors? (From Hearing Handicap Inventory – http://www.aaiaudiology.com/questionnaire.html)

47. THE HEARING HANDICAP INVENTORY - SCREENING FORM 6. Does a hearing problem cause you to attend religious services less often than you would like? 7. Does a hearing problem cause you to have arguments with family members? 8. Does a hearing problem cause you difficulty when listening to TV or radio? 9. Do you feel that any difficulty with your hearing limits or hampers your personal or social life? 10.Does a hearing problem cause you difficulty when in a restaurant with relatives or friends?

48. Best Practices: VR Services Referrals from FL School f/t Deaf & Blind Psychological Assessment Vocational Assessment Training Choices On-The-Job Training Job Placement

49. Best Practices: Working with Customers who are Deaf-Blind Division of Blind Services MOA with Division of Blind Services Dual-Case Referrals Helen Keller National Center

50. Unique Area Practices in the Delivery of VR Services Referrals Case Management Interpreter Service Arrangements Community Resources and Vendors