Going Beyond Communication: Functional Loss Indicators for Deaf and Hard of Hearing Consumers

1. Going Beyond Communication:Functional Loss Indicators for Deaf and Hard of Hearing Consumers Sheila R. Hoover, M.A., CRC RSA 5th National SCD Training Forum Baltimore, Maryland August 25, 2010

2. Back in the day… • Model State Plan created • Assisted programs to develop effective services and structure for D/HOH/DB/LD clientele • Advocated counselors with specialized skills • Advocated caseloads comprised exclusively of Deaf and/or Hard of Hearing consumers • Field staff had specialized training and understood the variety and severity of functional limitations caused by hearing loss-related disabilities

3. Staff and Policy Challenges • Long term RCD staff retire • Decrease in Deafness- and Hearing Loss-related Master’s programs • New staff with RCD skills assigned to mixed caseloads (general/D-HOH) • Spending caps and higher scrutiny of expenditures • Medical advances = more clients with most severe disabilities • Economic issues bring more general clientele to VR programs’ doors • Fragmentation in Deaf and Hard of Hearing communities • Deaf consumers seen as “high cost” cases • HOH consumers tend to avoid asking for help • “One VRC fits all” mentality more prevalent

4. “Deaf Videophone Users” Distribution in Oregon VR • Ad hoc data pull of VP users for SRC client satisfaction survey • Active with OVRS between 10/1/09 and 5/31/10 (includes those on OOS waitlist) • 96 individuals identified statewide * • 10% served by VRCs without ASL skills or specialized training • Slightly less than 50% in rural offices without RCDs *non-scientific data selection process used; sample may not be representative

5. “Deaf, Communication Visual” Distribution in Oregon VR Statewide caseload data as of 8/18/2010 Total Clients: 241 Case Assignment RCD n=178 73.9% VRC n=63 26.1% Branch Urban n=214 88.8% Rural n=27 11.2% VRC setting Urban n=38 60.3% Rural n=22 34.9% Data includes individuals presently on the OOS waitlist

6. “Hearing Loss, Communication Auditory” Distribution in Oregon VR Statewide caseload data as of 8/18/2010 Total Clients: 472 Case Assignment RCD n=112 27.3% VRC n= 360 76.3% Branch Urban n= 329 69.7% Rural n= 143 30.3% VRC Setting Urban n=216 45.8% Rural n=256 54.2% Data includes individuals presently on the OOS waitlist

7. What we really need is…

8. Purpose • What sets this group apart from other disability groups? • Why is this needed? • What do we want to accomplish? • How will it be used? • Who will use it? • When will it be used?

9. Strategy • Use pertinent, real-time data • AWARE/ORCA • Ad hoc requests to Data Analyst • Federal data (Census, RSA, Labor) • Develop with staff knowledge and skills • RCD workgroup • Management team presentation • In service presentation 2009

10. Influence • Administrator’s support from the start • State Plan goal tie-in • Winning management support • Repetition, repetition, repetition • Include in Staff Orientation/Counselor Training • Revise and distribute to staff statewide • Electronic and paper formats • Developmental process

11. Communication • What worked • What didn’t work • Field Testing • RCD group • Branch Managers • Statewide staff • Western Oregon University Interns & Faculty

12. Resources • OVRS Data Analyst • Real time data access • RCDs • Field test • Statewide management team • Quality Assurance staff • DHS Communications

13. Using the Tool • General orientation to form • Application to other disability groups • Documentation • Professional judgment • What it is NOT • Laundry list • Preferential treatment for D/HOH clients

14. Cassandra* • 55 year old female • Congenital Deafness, does not use speech • Reported work history: • Trapeze Artist 1981-84 • Farm laborer (1 month) 9-2004 • Fast Food cleaner 12-2004 to 2-2005 • Self-referred, gets SSDI • Requests help finding a job with benefits Sample case from Rural VRC

15. Cassandra* Disabilities • Deafness, communication visual, Congenital condition/birth injury • No description of severity, communication preferences, need for ASL interpreters as an accommodation Impediment to Employment COMMUNICATION: unable to communicate verbally COMMUNICATION: unable to converse via telephone Sample case from Rural VRC

16. Cassandra* 4. Documentation Describe how substantial VR services will reduce, eliminate or accommodate the participant's impediment to employment. • Assistive technology: use of video phone may help with communication which is impaired by deafness. • Specialized placement (including job coaching) may address work tolerance by helping client with job development and placement by exploring and accessing job opportunities consistent with her abilities, skills, interests, and functional limitations. This will include the identification of an employer willing to accommodate her communicative impairment due to deafness. • Substantial counseling and guidance: The VRC will meet with client on an ongoing basis to help her with decision making regarding her vocational goals which agree with her informed choice and functional limitations. Sample case from Rural VRC

17. Elmore* Communication: • Unable to communicate verbally.   • Limited ability to write English and to understand what is written to him.   • Unable to communicate on the phone.   • Difficulty communicating his thoughts due to limited language ability.   • Frequent misunderstandings in communication to receive job instructions.   Case example from RCD using Functional Loss Guide

18. Elmore* Interpersonal Skills:   • Difficulty interacting with co-workers due inability to verbally communicate.   • Frequent miscommunication causes the perception that he is not intelligent.   • Co-workers avoid him due to the difficulty in communication.   • He experiences isolation in the workplace.   • He may misinterpret co-workers behaviors from what he sees only, and become paranoid that he is the cause of such behavior.   • Unfamiliar with Hearing workplace culture causes him to behave in Deaf cultural ways which are misunderstood by hearing people.   • He is considered to be blunt or rude due to cultural differences between the Deaf and Hearing worlds. Case example from RCD using Functional Loss Guide

19. Elmore* Mobility: • Elmore has difficulty reading bus schedules and driver’s manuals due to low reading vocabulary and comprehension skills. Self Care: • Elmore does not know how to manage money or budget to maintain a stable home.   • He does not know how to report any earnings to Social Security.   • He does not know how to apply for low income housing, and needs help to complete the paperwork.   Case example from RCD using Functional Loss Guide

20. Elmore* Work Skills: • Elmore has limited English language reading and comprehension. • SAT scores in March 2008: • Reading Vocabulary 2.3 • Reading Comprehension 2.3   • He struggles with reading and has difficulty staying focused.   • He is unable to learn without a sign language interpreter or signing instructor/job coach. Case example from RCD using Functional Loss Guide

21. Keep in mind… Cautions Benefits Concise format Tool for adjustment to disability counseling May influence decisions on non-hearing-related disability function Better eligibility determination Better case planning • Statewide training status • RCD v. VRC skill differential • Impact on budget • Miscoded clients in data pool • Staff tendency to “rule in” not “rule out” • Manager buy-in and implementation

22. Next Steps • Distribute final version statewide • Work with field managers & QA staff • Add to Counselor Training curriculum • Local Rehabilitation Counselor Education Programs • Data monitoring • Continued training of existing staff

23. What we’ve learned… Any change, even a change for the better, is always accompanied by drawbacks and discomforts. Arnold Bennett HOWEVER… Change always comes bearing gifts.  Price Pritchett

24. Thank you for participating! Sheila R. Hoover, M.A., CRC State Coordinator for Deaf/HOH Services State of Oregon Office of VR Services 500 Summer Street NE, E-87 Salem, OR 97360 (503) 945-6255 Voice (503) 470-6740 Video Sheila.r.hoover@state.or.us