Going Beyond Communication: Functional Loss Indicators for Deaf
and Hard of Hearing Consumers
Going Beyond Communication: Functional Loss Indicators for Deaf
and Hard of Hearing Consumers
Sheila R. Hoover, M.A., CRCRSA 5th National SCD Training Forum Baltimore, Maryland August 25, 2010
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
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
“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
“Deaf, Communication Visual” Distribution in Oregon VR
Statewide caseload data as of 8/18/2010Total Clients: 241
Case AssignmentRCD n=178 73.9% VRC n=63 26.1%
BranchUrban n=214 88.8% Rural n=27 11.2%
VRC settingUrban n=38 60.3% Rural n=22 34.9%
Data includes individuals presently on the OOS waitlist
“Hearing Loss, Communication Auditory” Distribution in Oregon VR
Statewide caseload data as of 8/18/2010Total Clients: 472
Case AssignmentRCD n=112 27.3% VRC n= 360 76.3%
BranchUrban n= 329 69.7% Rural n= 143 30.3%
VRC SettingUrban n=216 45.8% Rural n=256 54.2%
Data includes individuals presently on the OOS waitlist
What we really need is…
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?
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
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
Communication
• What worked• What didn’t work• Field Testing– RCD group– Branch Managers– Statewide staff– Western Oregon University Interns & Faculty
Resources
• OVRS Data Analyst• Real time data access • RCDs• Field test• Statewide management team• Quality Assurance staff• DHS Communications
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
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*name has been changed for confidentiality
Cassandra*
Disabilities• Deafness, communication visual, Congenital
condition/birth injury– No description of severity, communication preferences,
need for ASL interpreters as an accommodation
Impediment to EmploymentCOMMUNICATION: unable to communicate verballyCOMMUNICATION: unable to converse via telephone
Sample case from Rural VRC
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
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.
*name has been changed for confidentiality Case example from RCD using Functional Loss Guide
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
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
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
Keep in mind…
Cautions• 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
Benefits• Concise format• Tool for adjustment to
disability counseling• May influence decisions on
non-hearing-related disability function
• Better eligibility determination
• Better case planning
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
What we’ve learned…
Thank you for participating!Sheila R. Hoover, M.A., CRCState Coordinator for Deaf/HOH ServicesState of Oregon Office of VR Services500 Summer Street NE, E-87Salem, OR 97360
(503) 945-6255 Voice(503) 470-6740 Video
