Presentation on theme: "Cecil introduces the program and vendors"— Presentation transcript:
1VR Staff Training – Area 4 Effective Delivery of VR Services to Individuals with Hearing Loss Cecil introduces the program and vendorsCecil thanks to Area 4 and supports (e.g., interpreters, CART, vendors)Cecil explains purpose and goals of this staff training as part of a “pilot training project”
2PresentersCecil 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 HealthCecil introduces key presenters
3Content of Today’s Program Deaf & Hard of Hearing PopulationDescriptions of hearing lossSigns and symptomsEmotional needsInterventionsCommunication modificationsAssistive technologyInterpretive servicesCecil introduces topics of this training program
4Content 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 DevicesCecil introduces topics of this training program (Continued)
5Learning Objectives We will learn to: Recognize 4 types of individuals with hearing lossRecognize the physical & emotional manifestations of hearing lossUtilize Best Practices in serving this populationUnderstand communication accessibilitySelect appropriate assistive technology & servicesUtilize available community resourcesCecil introduces key objectives of the training programCecil mentions that questions from the audience are welcome and will be answered as time permits
6What We Hear Valerie starts presentation with this slide Discuss how different noises impact or harm our hearing
7Unique Aspects of Hearing Loss TinnitusDistorted HearingHearing things that aren’t thereFeelings of fullnessDizziness & vertigoLoss of balanceCentral auditory processing disorderOtitis media & Otitis externaValerie continues presentation- Medical Aspects- Also, mention other causes of Hearing Loss (e.g., Deafness at Birth, Reaction to Medication, Head Injury, Noise)Counseling and Guidance– if the consumer mentions some of these symptoms, even if they are only looking for a hearing aid – suggest a follow up with an ENT referral because, if they can be medically treated, removing these symptoms can positively effect communication in the work place. If they cannot be treated, consumer gets disability awareness and education –possibly including information about triggers, etc for disability maintenance.
8Hearing Loss Descriptors Deaf Hard of Hearing Late Deafened Deaf-BlindValerie explains what she will address in regards to different types of hearing lossBriefly discuss why we do not use the word “Hearing Impaired.”
10Mild Moderate Severe Profound Levels of Hearing LossMild Moderate Severe ProfoundValerie to discuss differences in the levels (severity) of hearing lossMention decibels – as in loudnessMention hertz – as in pitch
11Audiogram ExamplesValerie to discuss differences in the levels (severity) of hearing loss using audiogram examplesLeft – normal and severeRight – two audiograms (top – neural; bottom – mixed)Counseling and Guidance – make sure the consumer can read their own audiogram since they will be getting audiograms to monitor changes for the rest of their life – they need to be able to understand the implications of changes.
12The Speech BananaValerie to discuss how different sounds appear on the audiogram and how the customer may experience inability to understand spoken words (speech), depending on the type of hearing loss
13Working with Individuals who are Deaf Sense of hearing is non-functional without the use of technological assistsMay be congenital or acquireddeaf vs. DeafValerie discusses deafnessCecil may wish to comment on deaf vs. Deaf
14Working with Individuals who are Deaf The Big “D” = Deaf Culture Deaf Pride Common Identity American Sign Language Recognition & AcceptanceValerie discusses deafnessCecil may wish to comment on the significance of Deaf Culture
15Working 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 rapidValerie discusses hard of hearing
16Working with Individuals who are Late-Deafened Hearing Loss usually severe to profound Occurs after speech and language are fully formedValerie discusses late-deafness
17Working 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.Valerie discusses deaf-blindnessCecil may wish to comment; mention that interagency involvement will be discussed later in this presentationCounseling and Guidance – Often, needs will be strongly affected by which sense was lost first – hearing or sight or both at the same time.Casework - For Deaf blind consumers, ask about DBS case and counselor contact information.
18Impact of Hearing Loss on the Customer Such Impact Can Be Gradual or Sudden! Emotional Aspects Physical Aspects RelationshipsValerie discusses how hearing loss impacts the customerCounseling and GuidanceTechnology – evaluate knowledge of assistive devices such as alarm clock, FTRI, motion detectors at front door for knocks, etc.Communication - Ask the consumers to evaluate what are more successful and less successful communication settings.Ask the consumers if they have developed coping skills in groups (if not, often feel isolated in family gatherings and work environments).Relationships and Independence - Ask about support systems and personal accommodations for independent living such as bill paying, etc.
19Emotions 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. AcceptanceValerie to discuss how customers respond to their own hearing loss.(This slide is revised to emphasize focus on individuals who are late-deafened or hard of hearing. Grief process doesn’t occur with those born Deaf)Also balance with positive experiences of those with hearing loss: (Stevie Question – if there is this – should it be followed by the positive experience of the Deaf person – a culture slide to compare…)
20Hearing Loss is Linked to: irritability, negativism and angerfatigue, tension, stress and depressionwithdrawal from family and social situationssocial rejection and lonelinessreduced alertness and increased risk to personal safetyimpaired memory & the ability to learn new tasksreduced task performance & independencediminished psychological and overall healthValerie continues to discuss how hearing loss impacts the customerCounseling and Guidance – evaluate for depression if warranted
21Communicating 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!Valerie provides a general overview on communicating with customers who have hearing loss
22Communicating with Individuals who are Deaf or Hard of Hearing Attention Noisy background Light Visual Obstacles & Foreign Objects Diction and Speech: Pace & VolumeValerie discusses issues and barriers that customers face while communicating
23Communicating with Individuals who are Deaf or Hard of Hearing Facial expressions and gesturesConversational transition cuesRephrase instead of repeatingTalk TO the Individual, not ABOUThim or her.When in doubt, ASKBe patient, positive, and relaxValerie discusses communication protocol
24Communicating 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.Valerie discusses how we should approach and communicate with a customer with hearing loss(This slide was revised by removing these words “stomp on the floor and hand slap a table” because that wouldn’t be appropriate in professional situation)
25Communicating with a Signer Always use interpreter for informed consentWhen the interpreter is present, talk directly to the individual who is deaf, not the interpreter.Don’t talk about the individual in their presenceDon’t say “Ask him/her” or “Tell him/her”Maintain eye contact. It is considered rude to carry on a conversation without eye contact.Valerie continues to discuss how we should approach and communicate with a customer with hearing loss
26Communicating with an Individual who is Deaf-Blind (DB) Notify the agency/interpreter that the individual is DBAdvise 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.Valerie discusses general practices in working with and communicating with a customer who is deaf-blindAfter this slide, we take a 15-Minute BREAK
27Assistive DevicesAlarm clocks Timers and watches Door signalers Phone/strobe signalers Paging systems Weather Alert systems Visual/auditory/tactile alertsCecil starts presentation with this slide on assistive devices, and mentions that we have an exhibit here on assistive devicesValerie may wish to commentCounseling and Guidance: discuss activities of daily living to see if there are assistive devices that they are unaware of. Encourage them to become familiar with a common retailer like or other similar site.(Picture from Library Services for the Deaf and HH Website: nashville.gov)
28Assistive Listening Devices Pocket sized personal amplifiers TV Listening systems FM Systems Loop Systems Various AccessoriesCecil discusses briefly about available devicesValerie may wish to comment
29Communication Devices TTYCell PhonesText/TabletsAmplifier/Clarity/Cap-Tel/Caption CallCecil discusses available communication devices, as well as those not shown here.Valerie and Stevie may wish to commentStevie question – are you going to mention Face time or Purple’s smart phone VP here? Maybe
30Personal FM System: See the Differences Cecil talks about differences or options found on personal FM systemsValerie and Stevie may wish to comment
31One-on-One Text Communication Cecil talks about UBI-DUO, a text communication device, as the choice for VR purchase and installment in field offices, in this slide.We have UBI-DUO as exhibitors here.Cecil also discusses plans on purchase of Personal FM System for selected field offices statewideCecil explains how important is it for VR field offices to have these handy.Valerie and Stevie may wish to comment
32Videophone and Video Relay Service Cecil presents on this slide. Discusses basic differences. More will be discussed in the afternoon as to their differences and what VR hopes to do with a VRI pilot project in selected field offices in the coming months.Valerie and Stevie may wish to commentCounselor guideline – note from Stevie – lots of Counseling and Guidance is taking place by VRS… should emphasize the rapport of face to face even though it may be difficult to get an interpreter.
33Free Telecommunications Equipment for Deaf & Hearing Connection of Tampa BayFree Telecommunications Equipment foreligible FloridiansTTY + Amplifiers/Clarity/Cap-Tel PhonesFlorida Relay ServiceCecil explains about the state telecommunications program for eligible Floridians with hearing lossCecil mentions that FTRI representative: Deaf and Hearing Connection of Tampa Bay, is here as an exhibitorValerie may wish to commentWe take an hour and 15 minute break for LUNCH!
34DVR Deaf & Hard of Hearing Services Role of DHHS at the State OfficeField & HQ Consultations and Staff TrainingBest Practices and CI/BAHA Prior ApprovalsHearing Aid MSUPCounselor & Staff Interpreter as a Working TeamGuidance from Rehabilitation Act of 1973/504, ADAUnique Services: Interpreting & Hearing TechnologyWebpage, VRI-NetCecil provides an overview of office functionsStevie may wish to comment
35VR Individual with Hearing Loss Served (2010-2011) Served Placed (26)Hard of Hearing ,Deaf ,Hearing & Visual*Deaf-Blind*Total ,*Both Combined - Classified as Deaf-Blind Per RSA 911 Coding (33/4)Cecil shares data on how many individuals with hearing loss received VR servicesStevie Question – there is nothing with one * - what does that mean? (Stevie, thanks. Corrected by Cecil )
36Buying a Hearing Aid: A Refresher First obtain Hearing Evaluation Report(Audiogram) & Recommendation fromQualified AudiologistsCompare vendor’s price with Manufacturer’s Suggested Unit Price (MSUP) on VR IntranetDiscuss with the IndividualCustomer Vendor Choice for Hearing Aid Fitting: Audiologist or Hearing Aid SpecialistDifference between Audiologist & Hearing Aid SpecialistCecil discusses VR best practices in purchasing hearing aidsStevie may wish to comment
37Best Practices: Hearing Aid Issues Hearing Loss vs. Vocational ImpedimentsHearing Aid Prices, Fees, & WarrantyHearing Aid ChoicesWhat about a Tele-coil?How often & how many Hearing Aids can VR buy?(Picture from Disability Graphics Website:Cecil continues to discuss VR practices in the purchase of hearing aidsStevie may wish to comment
38Best Practices: Cochlear Implant/BAHA Cochlear Implant and BAHA Checklist What Requires State Office Prior Approval? What about Replacements or Repairs? VR Intranet: Best Practices & FAQCecil discuss CI and BAHA as well as VR purchase of these hearing (medical) devicesStevie may wish to comment
39Best Practices: Meeting the Customer Available AccommodationsInterpreting ServicesCommunication DevicesComputer Access Real-Time Captioning (CART)(Picture fromCecil discusses available accommodations for customers with hearing loss – these may be discussed with the customer in early sessionsRequests for CART are rare; both interpreter services and CART are not provided at same time for just one customer per ADA Technical PaperValerie and Stevie may wish to comment
40Best Practices: Meeting the Individual for the First Time Acknowledging Differences Communication EtiquetteCecil adds pointers on VR best practices when working with customers who have hearing lossStevie and Valerie may wish to comment
41Best 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 NotesCecil adds pointers on VR best practices when working with customers who have hearing lossNote: if interpreting provided using interpreter, make a case note to document provision (even if it is a staff interpreter)Stevie may wish to comment(Local VR staff may wish to also comment)
42Best Practices: Functional Capacities MobilityCommunicationSelf-CareSelf-DirectionInterpersonal Skill Work ToleranceWork SkillsCecil adds pointers on VR best practices when working with customers who have hearing lossNote: if interpreting provided using interpreter, make a case note to document provision (even if it is a staff interpreter)Stevie may wish to comment(Local VR staff may wish to also comment)
43Best Practices: Working with the Individual Case Notes: What to document? Counseling & Guidance Method of Communication Customer Preferences: Auxiliary Aids & ServicesCecil adds pointers on VR best practices when working with customers who have hearing lossNote: if interpreting provided using interpreter, make a case note to document provision (even if it is a staff interpreter)Stevie may wish to comment(Local VR staff may wish to also comment)
44Best Practices: What to Ask the Individual Hearing Loss History & DiagnosisIs 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?Cecil discusses briefly on the importance of asking the right questions to gather information as to how hearing loss impacts the customer’s ability to communicate at home, at school, or at workStevie may wish to comment(Local VR staff may wish to also comment)
45Best 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?Cecil discusses briefly on the importance of asking the right questions to gather information as to how hearing loss impacts the customer’s ability to communicate at home, at school, or at workStevie may wish to comment(Local VR staff may wish to also comment)
46THE 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 –Cecil discusses this questionnaire that audiologists may ask customers with hearing loss – shares this with the audience as to what typical questions are used to ask the customer regarding his/her hearing loss experiencesValerie may wish to comment(Local VR staff may wish to also comment)
47THE 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?Cecil discusses this questionnaire that audiologists may ask customers with hearing loss – shares this with the audience as to what typical questions are used to ask the customer regarding his/her hearing loss experiencesValerie may wish to comment(Local VR staff may wish to also comment)
48Best Practices: VR Services Referrals from FL School f/t Deaf & Blind Psychological Assessment Vocational Assessment Training Choices On-The-Job Training Job PlacementCecil talks addresses other VR best practices – what to be aware and what we should be mindful in regards to the delivery of services to customers who are Deaf or hard of hearing as provided by our vendors – unique issuesStevie and Valerie may wish to comment(Local VR staff may wish to also comment.)
49Best Practices: Working with Customers who are Deaf-Blind Division of Blind Services MOA with Division of Blind Services Dual-Case Referrals Helen Keller National CenterCecil talk about joint DVR DBS efforts to better serve customers who are deaf-blindCecil mentions HKNC having a regional representative housed in Atlanta; Cecil also mentions local FOP at UF as well as local programs; Cecil also mentions a possible joint project with DBS and HKNCStevie may wish to comment(Local VR staff may wish to also comment.)
50Unique Area Practices in the Delivery of VR Services Referrals Case Management Interpreter Service Arrangements Community Resources and VendorsVR Area staff will be given an opportunity to share their unique practices in the delivery of VR services to customers who are Deaf or hard of hearing.Examples:Who handles Deaf & HH Cases?Procedures for securing interpreter servicesWhat happens when an interpreter is not available?Which vendors generally serve this population?Do you have a local medical consultant?
51Interpreter Credentials Interpreter BasicsHow do I use Interpreters? What Interpreter Skills?Maintain Eye Contact American Sign LanguageSpeak in First Person Manual EnglishDirect Conversation OralInterpreter CredentialsNational Certification: NAD/RID: NIC, NIC advanced, NIC master; NAD: IV & V; RID: CI, CT, CSC, IT, ICFlorida Quality Assurance Screening (QA): I, II, IIIStevie discuss interpreter interaction, skills and, credentials.
52Interpreter Basics (Cont’d) Hiring InterpretersTwo hour minimum for all assignmentsTwo interpreters for jobs that exceed an hourCertification level should match assignment needsInterpreter Disclosure Form (pending)Using Staff Interpreters vs. VendorsCredentials Used in VR officesWhen hiring from an agencyCancellations and No-ShowsFrom vendors or consumersStevie discusses interpreter qualifications and expectations(Local VR staff may wish to also comment.)
53Interpreter Basics (Cont’d) Vendors From Out of TownPaying for travelRegistering for transportation in RIMSWhy Family Members Should Not InterpretDocumenting in Case NotesInterpreting Manual UpdatesStevie discuss practices in arranging for interpreters for customers with hearing loss(Local VR Staff Interpreter may wish to also comment.)
54Section 504 of the Rehabilitation Act of 1973 (24 CFR Part 104) Section 504 states that "no qualified individual with a disability in the United States shall be excluded From, denied the benefits of, or be subjected to discrimination under" any program or activity that either receives Federal financial assistance or is conducted by any Executive agency or the United States Postal Service.(A Guide to Disability Rights Law, US Dept. of Justice, September 2005)Cecil discusses the importance of complying with Section 504 of the Rehabilitation Act of 1973Stevie may wish to comment
55ADA Title II (28 CFR Part 35)Title II of the ADA requires government entities to make appropriate auxiliary aids and services available to ensure effective communication . You also must make information about the location of accessible services, activities, and facilities available in a format that is accessible to people who are deaf or hard of hearing and those who are blind or have low vision. Generally, the requirement to provide an auxiliary aid or service is triggered when a person with a disability requests it.From: Dept. of Justice ADA Best Practices Tool Kit for State and Local Governments (CH. 3)Cecil discusses the importance of complying with Title II of ADA which is the same as Section 504 of the Rehabilitation Act of 1973, and to address auxiliary aids and services as well as effective communicationStevie may wish to commentThis was taken from:
56ADA Title II (28 CFR Part 35)“Effective communication” means that whatever is written or spoken must be as clear and understandable to people with disabilities as it is for people who do not have disabilities. The effective communication requirement applies to ALL members of the public with Disabilities, including job applicants, program participants, and even people who simply contact state or local government agencies seeking information about programs, services, or activities.Cecil discusses the importance of effective communication - ADAStevie may wish to comment]References: (DOJ ADA Title II Kit for State & Local Govt’s.)And (Southern California Registry of Interpreters for the Deaf Website Blog)
57ADA Title II (28 CFR Part 35)You must consult with the individual to determinewhat Is effective for him or her. Can you nameexamples of auxiliary aids and services?Cecil discusses the importance of providing auxiliary aids and services as well as providing qualified interpreter as defined by ADAStevie may wish to commentReferences: (DOJ ADA Title II Kit for State & Local Govt’s.)And (Southern California Registry of Interpreters for the Deaf Website Blog)
58ADA Title II (28 CFR Part 35)What is a qualified interpreter as defined by ADA?A qualified interpreter is defined to mean "anInterpreter who is able to interpret effectively,accurately, and impartially both receptively andexpressively, using any necessary specializedvocabulary."Cecil discusses the importance of providing auxiliary aids and services as well as providing qualified interpreter as defined by ADAStevie may wish to commentReferences: (DOJ ADA Title II Kit for State & Local Govt’s.)And (Southern California Registry of Interpreters for the Deaf Website Blog)
59What is the Difference?Video Relay Service (VRS) Video Remote Interpreting (VRI)Cecil or Stevie discusses the differences between video relay service and video remote interpreting servicesCecil or Stevie mentions VR potential pilot project at 3-4 sites statewide and its purpose
60Available VR Resources Deafness & Hard of Hearing - Section 4.18(also Best Practices Link )Interpreter Services, Telecommunications & Other Aids - Section 11.09Hearing AidsSection (also Best Practices Link )Out-of-State Schools (e.g. Gallaudet, NTID) - Section 13.07Cecil mentions available VR resources through VRI-Net
61Contact InformationCecil Bradley,Dana Lachter-Rivera,Deaf and HH Services, Program Resources SectionBureau of Field Services, DVRPhone: (850) (Dana)VP: (Cecil) or (Dana)Valerie Stafford-Mallis, Health Educator Consultant, Florida Coordinating Council for the Deaf and Hard of Hearing, Department of HealthPhone: ; (mobile text)Cecil closes session by sharing contact information for all three presentersCecil encourages VR staff to contact me or Dana if they have any questions or have issues, after they confer with their supervisors first
62Do You Have Any Questions? Evaluation Let’s Meet the Exhibitors Closing RemarksFinal CommentsDo You Have Any Questions?EvaluationLet’s Meet the ExhibitorsCommunication & Assistive DevicesPrograms and ServicesThank you!Cecil asks audience if they have any questions for the presentersWe pass out evaluation forms and ask them to fill them out.Then, Cecil introduces vendors by names again and asks the audience to go and see them and see demonstrations of their devices in the next hour.Remind them of closing time – 4:30p.Thank you!