1. Deaf/Hard of Hearing Sensitivity Training for 9-1-1 Personnel
Prepared by the Office for Deaf and Hard of Hearing Services (DHHS)
of the Texas Department of Assistive and Rehabilitative Services/Division for Rehabilitation Services, Austin
Presented by:
Please add your name and title to this slide

2. Deaf/Hard of Hearing Sensitivity Training for 9-1-1 Personnel
Why are we here?
Deaf/Hard of Hearing Sensitivity Training
for Personnel
Introductory slide

3. Demographics
8.8 % of general population has hearing loss
6.5 % are Hard of Hearing or Late Deafened
2.3% are members of the Deaf Community
At least 8.8% of the general population has a hearing loss sufficient enough to need on-going services (not hearing aid only). Some research is quoting 17% of the general population has a hearing loss of some significance. One study from John Hopkins reports 1 out 5 (20%) of persons over the age of 12 have a loss significant enough to impede their daily communication.
Of the 8.8% shown on this slide: 6.5% are categorized as hard of hearing or late-deafened and 2.3 are members deaf community. These numbers tend to be greater in rural areas and areas of lower socio-economic resources.

4. Growing Population with Hearing Loss
Aging population
Noise pollution
Illness and Injury
Life Expectancy
Fastest Growing Disability Group
Aging population - baby boomers are getting older and losing their hearing making hearing loss one of the fastest growing disability groups today, other factors include:
Noise pollution;
Illness and injury related conditions;
Life expectancy continues to increase.

5. A D A Americans with Disabilities Act Title II, Section 35.162
telephone emergency services shall provide direct access to individuals who use TTY’s and computer modems ...
Why was this done? Due to the extra time involved in making a relay call at the time of the original ADA mandates. Extra time was required due to:
Relay agent may have to locate the 10-digit number to call as the call might originate in Dallas but the call is being handled by a call center in Austin, Lubbock or during a peak period by an out-of-state “stand-by” center in Wisconsin or New Jersey. or
The PSAP ALI/ANI may not reflect the actual caller’s information if the software is down, the call is coming from
a rural area of the state or an Internet based source. Therefore, checking the name and address is ALWAYS essential.

6. Parts of the ADA I
Employment
Any entity employing 15 or more persons II
State and local government
III
Public accommodations IV
Telecommunications V
Miscellaneous
1. Disallows employment practices which are discriminatory against persons with a disability.
2. This is where our coverage is listed.
3. All other agencies, businesses are covered here.
4. Mandates that each state have a relay center at no costs to its users.
5. Disallows retaliation against persons (with or without a disability) who file a complaint using the ADA

7. Which ADA Title covers 9-1-1?
Only employees who have a disability II
State and local government – that is 9-1-1
III
N/A IV V
Cannot retaliate
3 and 4 are the only Titles which have no relevance to 9-1-1

8. Hearing Loss Categories
Presbycusis
Hard of Hearing
Late Deafened
Deaf
Deaf – Many are involved within the deaf community and in deaf culture and are native ASL users and the hearing loss was congenital; some may have become deaf as a young child, while others may have some residual hearing to aid in communication;
Late Deafened - a person, who after language acquisition, has lost most-to-all of their hearing as a result of an injury or illness;
Hard of Hearing – a person, of any age, with usable residual hearing which may (and probably will) be assisted with amplification;
Presbycusis – deafness or severe hearing loss due to age and/or illness

9. Leading Indicators to English Proficiency for Persons who are Deaf
Age of Onset
Age of Identification
Severity of Loss
Initiation of Amplification Intervention
Initiation of Educational Intervention
Level of Intelligence
Parental Involvement
These are the major factors leading the functional reading/communication level for persons who are deaf/severely hard of hearing.
Age of Onset
a child deaf at birth is already 3 months behind a hearing peer
At birth, a hearing child is already aware of the environmental noises at their home (if the parents were living in what will be the child’s home). For example, if close to train tracks, the infant will sleep through a passing train. They already know their mother, father and sibling’s voices while in utero.
This begins to take place at about 6 months after conception so therefore at birth, the deaf child begins life 3 months behind their hearing peer.
basic language and the corresponding rules are known by the typical 3 year old
Although the child cannot “quote” the grammar and language rules, most 3 year olds know that if something happened yesterday that the verb needs a past tense form. They may not use the right tense but they know one exists!
the longer hearing is at a normal status before being impaired, the greater the English, reading and communication abilities will be of the individual, typically.
The longer a child has hearing and acquires more language knowledge, grammar structure and vocabulary, the better for their base knowledge later in years.
Age of Identification
Some children are born deaf and it is not noticed/recognized until all their peers begin to talk and make sentences (everyone things he/she is just a bit slow). Or maybe a toddler has a bad case of something a looses some hearing and because they are already talking it goes unnoticed for several months until their speech begins to become unintelligible (children will quit putting “s’s” on or in their words as this is the most hardest sound to hear).
the earlier the hearing loss is noticed and identified, the better
an unnoticed loss of hearing can create problems at whatever age
the younger- the worse the situation and course of remediation
Severity of Loss
there are mild, moderate and severe categories for persons who have a loss of hearing; however the differences in hearing losses are as many as there are persons who have one
Most mild hearing losses can be “fixed” with a hearing aid. All other levels of hearing loss cannot be “fixed” without giving up something in the process.
variables include: level of decibel loss, level(s) of hertz involved “(high frequency/low frequency, etc.)”
Decibel is how loud a sound is.
Hertz is whether the tone/sound is low pitched or higher pitched.
Some people can hear low pitches well but need the sound (decibel) increased in order to hear and understand higher pitches well. Others are just the opposite. Someone who has normal hearing in the lower levels but needs much amplification in the higher pitches may never become use to a hearing aid, as an aid (unless one of the newer $5, aids) will amplify all sounds to some degree, thus lessening the effectiveness of the aid.
Initiation of Amplification Intervention
again, the earlier the appropriate intervention the better
hearing aids (amplified hearing), cochlear implants (artificial hearing) and FM amplification systems are a few of the resources available, yet expensive
Cochlear implants are major surgery and requires months of intense therapy afterwards in order to learn to use the device effectively
Initiation of Educational Intervention
programs are now available at birth for infants who are deaf or hard of hearing
Services are getting better in order for services to begin as soon as possible
new legislation requires hearing screening of all newborns in counties of populations above 50,000 for earliest intervention possibilities
Level of Intelligence
level of intelligence has a direct relation to all capabilities (even more so in this situation) to assist in overcoming the communication disorder imposed by the loss of hearing.
Parental Involvement
the more active a role with their child with a hearing loss, the better for the individual child
parents of deaf/hard of hearing children often just accept the word of the “professionals” and do not seek out appropriate options.

10. Why it might be difficult to learn English, especially if you don’t hear it: The bandage was wound around the wound. The farm was used to produce produce. We must polish the Polish furniture. Since there is no time like the present; he thought it was time to present the present. A bass was painted on the head of the bass drum. They were too close to the door to close it. The buck does funny things when the does are present. After a number of injections my jaw finally got number. Upon seeing the tear in the painting, I shed a tear. I had to subject the subject to a series of tests. The soldier decided to desert his dessert in the desert.
Have the audience read to themselves and then ask for some volunteers to read their favorite one.
Ask:
which one they had the hardest time figuring out;
did they use their hearing to figure things out (did they read to themselves);
how would someone who had never heard be able to do this?

11. Do you know any signs or gestures?
How about…..
baseball
bowling
swimming
baby
drink
eat no
yes
cry
talk
write
walk
brush teeth
brush hair
bath
hot
cold
Many are natural movements - Baseball, like swinging the bat; bowling, like bowling the ball; swimming, depends on the stroke you are using; baby, holding the baby in your arms, drink, with a four fingers and the thumb it is non-alcoholic, with just the forefinger and thumb it is alcoholic; eat; either like with a fork but the more accepted sign is closed “O” hand to the mouth; No, is the thumb, fore and middle fingers coming together like your Mom saying “NO” or you shake your head; yes, is the “s” hand shaking like your head nodding; cry, left and right hands interchangeably drawing the tear lines or just one handed is fine as well, talk, left/right (one or both) hands opening/closing like a mouth or more acceptable is right and left forefingers at mouth moving back/forth; write, like writing on a pad; walk, full open hands palm down like footsteps or fore and middle finger being the legs and walking; brush teeth, brush hair and bath, nature movements; hot, taking something from mouth and throwing it away or using forefinger to remove sweat from the forehead, cold, left and right “s” hands shaking as if you are cold

12. Communication Methods
Sign Language: Linguistic research has shown many sign languages (American Sign Language is one) have their own grammatical structures, syntax, rules, etc., like spoken languages.
Universality: Sign languages are not universal. Like spoken languages, sign languages around the world are entirely different. ASL is primarily used in America and Canada. However, fluent sign language users do have advantages over spoken languages users. The monolingual signer can communicate with other foreign signers much easier, using gestures, body language and pictorial expressions, than monolingual (spoken) persons in a foreign country.
American Sign Language (ASL): ASL is not an abbreviated form of English nor is it a simplified version. It is the native language most persons who are deaf in America use.
Let them read the information and talk about it

13. Communication Methods (continuation):
Home Signs: In some very rural areas, deaf children and their family members use home signs when they are not exposed to any other people who are deaf or the Deaf community.
Oral/Aural:
Oral is where the child is taught to use their speech and speech-reading abilities. Age of onset, identification/amplification onset, severity of loss all play an important role in the level of success.
Speech-reading or lip-reading is an innate ability. A person (deaf or hearing) is either born with the ability to do so or is not born with the ability to do so. You can improve the skill for someone with the innate ability but you cannot teach someone born without it.
Sign Systems: a combination of signs used in English word order, which sign the word and not the meaning - used mostly in educational settings to help improve English proficiency
Let them read and talk about the information

14. Communication Methods (continuation):
Oftentimes, many years of trying to teach (improve) the ability passes before it is realized that the child will not succeed with the chosen method. Much information can be lost during these formative years.
The most proficient of speech-readers can only catch about 25% of a known topic/conversation. This lessens to about 15% when the topic of conversation is unknown as the context on which to base one’s guesses is lowered. Many English sounds look alike on the lips and many words look alike on the lips. The anatomy of the speaker and the environment influence the “read-ability” - thin lips are difficult to read, as are the lips of someone with a full beard/moustache. It is most difficult to read some one who is writing on a blackboard (school settings) and extremely difficult to follow the subject matter on films that have voice-overs (speaker is not presented on the screen) or includes animation.
Aural is where the child is taught to use what residual hearing (amplified or not) they may have to their best benefit. Some schools advertise that they “teach deaf children to hear.”
Let them read and high-light the important parts – use you favorite list of words that look alike or use you favorite lip-reading story

15. Communicating with Individuals who are Hard of Hearing/Oral Deaf
Slow down
Don’t yell
This distorts your words, making it difficult for those who are trying to lip-read
Don’t repeat the same statement over and over
Rephrase the statement
Sometimes more words help capture what you are saying
If you must spell say:
“B” as in Baseball
“P” as in Paul
Separate numbers that sound similar
For example 50 and 15, or 50 and 60
for 50 and 15 say five/zero and one/five
Be patient
On the “if you must spell…..” to someone with a severe hearing loss ‘c,’ ‘b,’ ‘d, ‘g’ can all sound alike so the corresponding word helps.

16. Practice fingerspelling your name.
The Manual Alphabet -one of the few commonalties in the numerous sign systems in use in America
Names of people, places and things and specialized terms must be fingerspelled as there are usually no signs for them:
What you see is what the viewer should be seeing. The “signer” will be seeing the back of the hand in most cases.
Practice fingerspelling your name.

17. Deaf Parents/ Families
What is Deaf Culture?
Deaf Culture
Identity
Pride
Folklore
Deaf Parents/ Families
Residential Schools
Emotional Support
As with any culture, there is an identity with someone who experiences life the same way as you.
Deaf are proud of their heritage and strives they have made to live in a hearing world.
Stories abound within the Deaf Community. Storytelling is an important part of any Deaf event.
True Deaf culture usually has other members of the family as being deaf as well and mostly were educated in their state’s residential school for the deaf
Identity and emotional support almost go hand-in-hand.

18. Cultural Behaviors - Deaf/Hearing
* Getting Attention
*Flickering of lights or
stomping on wooden floor vs calling, “Hey”
*Staying in the kitchen where there is more lighting vs the living room
* Party
It is easier to sign if you are standing or sitting across from each other so deaf tend to stand in the kitchen and talk instead of sitting in the living room, lined up on the sofa, to chat
An introduction with deaf people includes whether they had deaf parents and siblings , what schools for the deaf they attended….
Pointing is part of their daily communication and is considered essential and not rude
*Long introductions with questions vs “Nice to meet you”
* Introductions
* Considered necessary vs considered rude
* Pointing

19. Who Invented the Telephone and Why?
Alexander Graham Bell
He was trying to help his wife, who was deaf, obtain a better life through an electronic amplification device.
In 1876, his creativity resulted in something she and millions of individuals who were deaf or hard of hearing could not use for almost 100 years.
Discuss the slide

20. 1904
Phones were not useable by deaf/hard of hearing when they looked this

21. 1927
Or when they looked like this

22. 1963
Or even when they looked this.

23. Early 1970’s
This was the machine that first allowed deaf people to “use the phone” - old teletype machines hooked up with computer modems. These machines weighed about 300 pounds and took up allot of room. These first machines were donated from old warehouse leftovers of Western Union, National Forecasters and others to Pioneer Clubs of America (volunteers from SW Bell, here in Texas - mostly). These machines were refurbished to accept the modems and then distributed to people who were deaf. Would you have wanted this in the corner of your living room?

24. Mid/Late 70’s
When technology made these smaller machines obsolete, then they were refurbished and donated to the deaf community. They were a little bit smaller but were still noisy, ugly and hard to type on.

25. 1980’s ’s
There are many different types and makers of TTYs today. Some are very small and very portable but really they are being used less and less as better technology becomes affordable.

26. TTY Users
Persons who are deaf, pre-lingually
Persons who are deaf, post-lingually
Persons who are hard of hearing
Persons who are deafened as an adult
Persons who are speech impaired
Others???
The last group are any hearing person who wants/needs to communicate with a person from the first 5 groups

27. TTY Related Words/Definitions
Relay Service
Telephone relay service allowing persons who have a TTY to call persons who do not and vice-versa
Direct Access
The ability to directly receive a call with out third party services
Baudot
Code used by TTYs
ASCII
American Standard Code of Information Interchange
Code used by computers and facsimile machines
Discuss the slide

28. Devices used by persons who are deaf/hard of hearing:
Telephones:
TTY
Amplified phone
Pay Phone with TTY
Pay Phone w/amplifier
● Hearing aids, cochlear implants, digital hearing aids, assistive listening devices
Many of the ways that technology helps deaf/hard of hearing people stay in the mainstream
Pager
Digital
Text
Wireless 2-way

29. Other devices to assist persons who are deaf/hard of hearing function in their daily lives:B  
In a deaf/hard of hearing person’s house, lamps flash on and off to alert them that someone is at the doorbell or the phone is ringing. The pillow vibrates to wake them up or to let them know the baby is crying in the next room. The fire alarm flashes with 1000 lumens of light and/or a high decibel in order to awaken someone who is sleeping. NN

30. Types of TTYs Discuss the slide Acoustic
Telephone receiver must rest in TTY coupler
Direct Connect
Telephone line plugs into TTY and separate phone implement is not necessary – “dial” from keyboard
Acoustic/Direct Connect
Some have either/or capabilities
Discuss the slide

31. What’s that sound?
Take a TTY with you and key-in so they will know the difference between baudot and fax sounds

32. Types of TTY Calls Traditional VCO (Voice Carry Over)
HCO (Hearing Carry Over)
TTY via relay service
VCO via relay service
HCO via relay service
(Each is discussed on other slides)

33. Types of TTY Calls
TRADITIONAL
TTY
TTY
Discuss the slide

34. Types of TTY Calls VCO (Voice Carry Over)
User has intelligible speech and prefers to speak instead of type to you.
faster than traditional TTY call;
popular with persons who are late-deafened and hard of hearing - typing speed is slow due to age/arthritis and/or never using a keyboard previously.
Discuss the slide

35. VCO Phone
This is one of the VCO phones made for late-deafened and hard of hearing persons and make using the TTY a little bit easier

36. Types of TTY Calls HCO (Hearing Carry Over)
Users are speech-impaired (cerebral palsy, stroke victims, etc.)
faster than traditional TTY call;
they listen to your voice and they type to you.
Discuss the slide

37. Types of TTY Calls Traditional via relay service VCO via relay service
HCO via relay service
all as previously describe with exception that a relay agent is involved

38. Is this call a TTY/TDD call?
Electronic tones
does not sound like a fax but is often confused and hung-up on or transferred to fax machine
Silence (open line)
older machines and older users do not “key-in” to alert you the call is from a TTY/TDD
Synthesized voice announcement
many newer machines have this option (will not be recognized by your PSAP and TDD Challenge button is required to activate)
Relay agent
no need to activate the TDD Challenge button or get your TTY/TDD
Discuss the slide

39. A few TTY Abbreviations
MSG - message
CUD - could
B4 - before
U - you
Pls - please
NUM - number
R - are
Many, many others
GA - go ahead
SK - stop keying
GA to SK - I’m ready to hang up, are you?
SKSK - hanging up
Q - Question mark
xxx - error
CUL - see you later
Just a few of the abbreviations used;
This use to be pretty unique to TTY users but with the advent of IM…….these are many others are commonplace today – the deaf led the way for instant messaging!

40. Free service that is available 24 hours a day, 365 days a year
Relay Texas
Relay service mandated by ADA under Title IV, however, Relay Texas opened prior to ADA mandate
Enables person with TTY to call person/business who does not and vice-versa
Free service that is available 24 hours a day, 365 days a year
7-1-1
Some preferred relay services of today are not obtainable through 7-1-1

41. Technology and Relay Updates
IP Relay Service
Problems?
Internet based, so ANI/ALI may not be present if the person is not in compliance with FCC regulations. Providers are nationwide and your relay agent may be several states away and unfamiliar with regional/slang terms. Previously, incoming calls could not be received by IP Relay users, they now can.
Video Relay Service
Although communication is much smoother and quicker because the person is using their primary language with which to communicate, the same problems may be present as it is Internet based.
Captioned Phone Relay Service
This phone/service uses voice recognition software. When the caller dials a number, the phone automatically routes the call first through a CapTel transcription center. There, everything you say is restated by a third party, or communication assistant, (since software must learn to understand the speaker) which in turn becomes text for the caller. In the case of CapTel phones, when a CapTel phone dials 9-1-1, it automatically becomes a VCO phone and bypasses the CapTel transcription center. You will handle this as a VCO call.
Discuss the slide

42. Relay Protocol Discuss the slide
Immediately verify address and phone number with the caller
Speak in “first-party” language
Don’t solicit opinion or comment from the agent, operator, or communication assistant
Do handle the call just as you would any other but add a “GA” or “SK” at the end
Discuss the slide

43. TTY-ASL Translations mom eat pills wake no knife cut arm blood blood
bad man hurt head me
fire house near lake baby inside
bridge old here friend hole fall stuck him
head hot weak me sick pls help
My mother took some pills and is unconscious
My arm has been cut with a knife and it is bleeding (we don’t know if they accidentally cut it or if someone else cut their arm)
Someone who accosted me and injured my head
A house near the lake with a baby inside is on fire
My friend has fallen in a hole in the old bridge and is stuck
I have a fever, I am weak and sick, please help me.
There will now be two hands-on exercises to help you with working with an ASL user on a TTY.

44. The TTY Call Adjust Your Language
Exercise One
Keep an open mind when reading the message
Exercise Two
The average Joe walking on today’s street with normal hearing who graduated from high school has about an 8th grade reading level. The average “deaf” Joe has only about a 4.8 reading level due to one or more of the factors we learned about earlier. Average means there are some higher and some lower. Today’s exercise are designed to help you effectively communicate with a deaf TTY user who has about a 2nd – 3rd grade reading level. If you can communicate with this “Joe” then you will be able to communicate effectively with most TTY callers needing some form of assistance!
Joe’s TTY may or may not have a printer and the printer may or may not be working. His TTY only show 25 characters at a time, the last 25 you typed. If you ask 2 or more questions at a time, only the last one will show and he may not respond and give you important information.
Joe has come in from a long day of work to find his wife unconscious on their kitchen floor and there is a step stool on its side nearby. It looks like she was trying to reach for something in an upper cabinet, fell and may have struck her head. He is calling you. Their TTY and phone (probably not cordless) is on the counter on the other side of the room. He is probably going back and forth from his wife on the floor and the TTY on the counter which complicates things. On exercise one: These words are common to emergencies and they are not in Joe’s 2nd grade reading vocabulary. Think of other words that will communicate the main idea to Joe.
Exercise Two: Look at these ASL sentences and determine the English equivalent sentence.
Now Review the Post-Test for full comprehension!
Remember:
Ask your questions one at a time!

45. Wrap Up…..
Questions
Post-Test
Evaluation
Thanks!