supporting deaf or hard of hearing individuals with ......agenda- for our purpose • senses •...

Collaboration between:

Department of Human Services,

Office of Developmental Programs, Special Populations Unit

&

Department of Labor and Industry,

Office for the Deaf & Hard of Hearing

Supporting Deaf or Hard of

Hearing Individuals with

Developmental Disabilities

• Office for the Deaf & Hard of Hearing

– Melissa Hawkins, Director

• Office of Developmental Programs, Special

Populations Unit

– Lea Sheffield, Special Populations Unit Manager

– Lori Milcic, Deaf Services Coordinator

– Krista Lewis, Communication Professional

– Kelly Ruiz, Communication Professional

Agenda- for our purpose

• Senses

• Types and levels of hearing loss

• Link to how it impacts deaf individuals with ID/DD

• Deaf culture

• Receptive/expressive communication

• Visual environments

• Assistive Technology (AT)

• Types of interpreters

• Best practices for interpreters

• Language deprivation

• Effective support strategies

• LifeCourse tools

What are the 7 senses?

• Sight

• Smell

• Taste

• Hearing

• Touch

• Vestibular- Movement and balance

• Proprioceptive- Body position

Sight or Vision

• Coordinates other senses

• 70% of information is received visually

• Reduced socialization

• Color discrimination

(7 Senses Foundation, 2013)

Smell or Olfaction

• Better awareness of the environment

• Interconnection with memory and language

• Linked to taste and appetite

• Alerts us to danger

(7 Senses Foundation, 2013)

Taste:

2/3 of taste depends

on smell

Taste or Gustation

• Can be decreased

• Relates to our quality of life and protection

• Alerts us to danger

• Well developed at birth and diminishes with age

83%50%

of taste buds are

lost by age 65

of taste buds are

lost by age 70

(7 Senses Foundation, 2013)

• Impaired

• Ability to detect vibrations

• Aspects of a hearing loss diagnosis

– Unilateral (one ear) or bilateral (both ears)

– Type of loss: where the disturbance occurs• Conductive, sensorineural, mixed

– Degree of loss: how much someone can hear• Mild, moderate, severe, profound

Hearing or Audition

(7 Senses Foundation, 2013)

Types of Hearing Loss

Auditory

Nerve

Ear Canal BonesCochlea

Degrees of Hearing Loss

• Degree of loss– Mild

– Moderate

– Severe

– Profound

• High and low

frequencies

• Loud and soft

sounds

Touch or Somatosensory

• Critical supportive sense

• Loss of touch receptors

– Peaks between the ages 16 and 18

• Tactilely defensive

(7 Senses Foundation, 2013)

(Alsop & SKI-HI Institute, 2002)

Vestibular System

• Housed in the three semi-circular canals

– One for each: horizonal, vertical, and diagonal balance

• Informs and relates to:

– Balance- combination of vision, vestibular, and proprioception

– Gravitational changes

– Movement- accelerated or decelerated

– Which way is “up”

– Postural control

– Feeding skills

– Coordination of eye and head movements

• Example: Knowing you are moving while standing

still in an elevator(7 Senses Foundation, 2013)

(Brown, 2007)

(Scoggin, 2018)

Cochlea

Semi-

Circular

Canals

Vestibular System

• May crave spinning, jumping, or constant

movement

• May frequently slump down, lay down, or appear

“floppy”

Red Flags- Vestibular System

• Dislikes or seeks out activities requiring feet to leave the

ground

• Excessive spinning doesn’t cause dizziness

• Poor safety awareness or impulsive jumping, running

and/or climbing

• Rocking, spinning, or twirling (constant movement)

• Poor eye hand-eye or eye-foot coordination

• Unsteady gate

• Poor postural control- laying down, slumping, appearing

“floppy”

• Afraid of going down stairs

• Dislikes tilting head backwards

Proprioceptive System

• Tells us about the position of the body and limbs

• Know body position without looking or touching

• Located in our muscles and joints and sends

information to the brain

• Does not require vision

– Example: clapping hands together while eyes are closed

• Impacts fine motor skills, spatial and body

awareness, and applied force

• Seek proprioceptive input

(7 Senses Foundation, 2013)

(Scoggin, 2018)

Red Flags- Proprioceptive System

• Kicking when sitting

• Stomping when walking

• Seeking deep pressure

• Difficulty judging force or distance

• Slumping

• Walking on tip-toes

• Chewing on shirt

• Frequent hitting or pushing (self or others)

• Moving too quickly

• Crashing into things

Why is this important?

Each sense (separately and together) impacts every day life

• Communication

• Socialization

• Daily tasks

The person may struggle to communicate their challenges

• Symptoms of dysfunctional senses may be incorrectly viewed as “behavior”

• Requires an informed observer

Strategies can be implemented to better support them

Deaf History, Culture, and Norms

Deaf History

• Martha’s Vineyard

• Institut National des Jeunes Sourds

• 1817 first school for deaf children opened in Connecticut

• Laurent Clerc and Gallaudet

• 1864 President Abraham Lincoln signed an Act of

Congress

• Oralism and Alexander Graham Bell

• 1880 National Association of the Deaf was formed

• 1964 TTY

• 1964 founding of the Registry of interpreters for the Deaf

• 1990 Americans with Disabilities Act

Deaf Culture

• Rooted in language

• Deaf first language

• Minority group

• Signed Identification

• History

• Blunt/Direct (appear rude)

• *Not disabled*

• Identification and unity with

other people who are Deaf

American Sign Language (ASL)

• Visual language

• Grammatically complex

• Different from a communication code

designed to represent English directly

• Not Universal

• Introductions

• Eye contact

• Pointing

• Facial expressions

• Leaving

• Getting one’s

attention

• Physical touch

Cultural Norms

Technology

• Changes Deaf Culture

• Instant Messaging

• Blogging/Vlog

• Video Captioning

• Does not change Real Life Communication

Recent Changes in Deaf Culture/Community

• Cochlear Implants

• “if it isn't broken, don’t fix it!”

Considerations

for

Communication

The Basics of CommunicationCommunication:

The successful conveying or sharing of ideas and

feelings

Language:

The method of human

communication, either spoken,

signed, or written, consisting ofthe use of words in a structured

and conventional way that is

accepted and used by multiple

people.

Modes of Communication:

Any method of expressing/receiving

information without the support of a

structured or conventional way of

communicating. This may include,

but is not limited to, facial

expressions, drawing pictures, and

body movements.

Considerations for Communication

Basics of Communication

Languages

English

Mandarin Chinese

American Sign Language

Spanish

French Sign Language

Portuguese

Swahili

Modes of Communication

Spoken or Signed Language

Speech Generating Devices (ie. Tablets

with a Speech Generating App)

Picture Boards

Visual Gestural Communication (VGC)

Tactile Cues

Picture Exchange Communication

System (PECS)

Behavior- what happens when effective

communication is not accessible

Example: boredom, annoyance

“I can’t believe we

spent 3 hours in a

meeting that could

have been an email.”

Mode of Communication:

Visual Gestural Communication/

Paralinguistic

Basics of Communication

Language:

Spoken English

Augmentative and Alternative Communication

Describes various methods of communication that can help

people who are unable to use verbal speech to

communicate. *Not just for people who have disabilities

Writing Texting Facial Expressions

Memes Sign

s

Vocal Expressions

Source: American Speech-Hearing Association (ASHA), 2019

Augmentative and Alternative Communication

Aided:

Any tool or device used

to support

communication.

Unaided:

Any body movement

used to support

communication body.

Source: American Speech-Hearing Association (ASHA), 2019

Augmentative and Alternative Communication

Unaided:

• Body Language

• Visual Gestural

Communication

• Eye Gaze

• Haptics/Touch Cues

• Paralanguages

• American Sign

Language

• Foreign Sign

Languages

• Signed Exact English

• Pidgin Sign Language

Augmentative and Alternative Communication

• Pencils and Pens

• Paper

• Pictures/Illustrations

• Instant

Messaging/Texting

• Braille

• Speech Generating Devices

• Picture Exchange

Communication System (PECS)

• Picture Systems

• Symbol Systems

• Artifacts

• Tactile Cues

• Object of Referral

Aided

Assistive Technology for Communication

“Any item, piece of equipment, or product

system, whether acquired commercially off

the shelf, modified, or customized, that is

used to increase, maintain, or improve

functional capabilities of a [person] with a

disability.”

(Source: Individuals with Disabilities Act, 2019)

Categories of Assistive Technology (AT)

Low/Light

• No energy source

• Little training

• Most common

• Examples:

• Highlighter

• Stress ball

• Velcro

Mid

• May have an energy source

• Maybe some training

• Least common

• Examples:

• Calculator

• Adaptive switch/toys

• Adapted seating

High

• Has an energy source

• Requires training

• Examples:

• Electronic tablet

• SMART board

• Specialized alarm system

The Overlap Between AT and AAC

Communication System AT AAC

Spoken Language No No

ASL No Yes (unaided)

Eye Gaze (without a device) No Yes (unaided)

Eye Gaze (with a device) Yes (high tech) Yes (aided)

Voice Output DevicesYes (mid-high

tech)Yes (aided)

PECS Yes (low/light tech) Yes (aided)

Print Systems Yes (low/light tech) Yes (aided)

Braille Yes (low/light tech) Yes (aided)

Symbol Systems Yes (low/light tech) Yes (aided)

8/23/2019 35

• Receptive– Understanding when others

communicate

– Often by the receiver

– Listening and understanding

– Can be understood or

misinterpreted

Expressive and Receptive Communication

• Expressive– Communication is understood

by others

– Often through the sender using

various/multiple modes of

communications (sometimes

more than 1 at the same time)

– Can be intentional or

unintentional

Expressive Communicator Strategies

Do:

• Get the person’s attention before you begin

communicating

• Communicate about concrete concepts

• Keep your directs clear and direct

• Give ample wait time for processing

• Provide eye contact but don’t expect it in

return

• Use the person’s name

• Give explanations and/or demonstrate what

you’d like the person to do

Expressive Communicator Strategies

Don’t:

• Use jargon, slang, or abstract

(use key words)

• Communicate quickly without

providing processing time

• Give too many directions at

once

• Assume someone doesn’t

need more information

Do:

• Be aware of the expressive

communicator’s

communication needs

• Establish trust

• Use whole body listening

Receptive Communicator Strategies

Receptive Communicator Strategies

Don’t:

• Assume someone can receive

communication the same way they

expressed it

• Forget to use facial expressions, body

language, and other indicators to let the

expressive communicator know you are

receiving their information

*Impacts of internal and external factors vary for both the sender and receiver

• Sensory and Environmental

• Smells

• Sounds

• Lighting

• Clutter

• Crowds

Internal Factors

• Culture, Experiences

• Health and Physical barriers

• Nonverbal Communication

• Emotions and tone of the communication

External Factors

Affects Communication

Challenges and Solutions

Clutter, Physical Barriers, and Space

Additional Modifications

Corner Mirrors- see

around corners and

down hallways

Acoustic Tiles-

absorb background

noise instead of

blocking the sound

Additional Considerations

• Seating

• Mobility and proximity

• Visual cues: – Calendars

– Schedules

– Charts

46

Best Practices

Working with Interpreters

Misconceptions about Interpreting

• The Deaf person will bring their own interpreter if

they need one.

• A family member can interpret for them; they

don’t need a certified interpreter.

• Someone who has taken sign language classes

or knows A-B-C fingerspelling can act as the

interpreter.

• The Deaf person can read my lips.

– Can You Read My Lips? Video

• The Deaf person can write back and forth.

Obligation for Effective Communication

• Americans with Disabilities Act (ADA)

– https://www.ada.gov/regs2010/titleIII_2010/titleIII_2010

_regulations.htm

– https://www.ada.gov/effective-comm.htm

Title iii requires “appropriate auxiliary aids and

services where necessary to ensure effective

communication with individuals with disabilities.

This includes an obligation to provide effective

communication to companions who are

individuals with disabilities.”

Definition of Interpreter

From the National Association of the Deaf:

A qualified interpreter is one who can, both

receptively and expressively, interpret accurately,

effectively, and impartially, using any necessary

specialized vocabulary.

Breaking Down the Definition

Qualified interpreter:

• PA Act 57 – Registered

https://www.dli.pa.gov/Individuals/Disability-

Services/odhh/interpreters/Pages/Act-57.aspx

• Registry of Interpreters for the Deaf (RID) – Nationally Certified

rid.org

• Type of Interpreting

– Deaf Interpreter

– Tactile Interpreter

– Oral Interpreter

– Video Remote Interpreter

– Video Relay Service

Breaking Down the Definition

• Receptive, expressive

–RID Certification is a start

–Interpreter tools

•Deaf person’s language

•Hearing person’s language

–Session participant tools

•Assessing effectiveness yourself

•Having someone else assess effectiveness

Breaking Down the Definition

• Accurate, effective, impartial

– RID Code of Professional Conduct (CPC)

• Confidential communication

• Professional skills and knowledge required for the specific

situation

• Conduct themselves in an appropriate manner to the

specific situation

• Respect consumers

• Respect colleagues, interns, and students of the profession

• Maintain ethical business practices

• Engage in professional development

https://www.rid.org/ethics/code-of-professional-conduct/

Breaking Down the Definition

• Specialized vocabulary

–Legal

–Medical

–Educational

–Religious

–Mental/Behavioral Health

• Qualified Mental Health Interpreter (QMHI)

–Organizational lingo

• Providing prep material in advance

Now What? (BEFORE)

• Hire your interpreter(s) in advance (2-3 weeks is best)

– 2 interpreters needed for complex, lengthy, dysfluent

interpretations

– Budget for interpreting costs before the need arises

– Freelance vs Referral agency

• If using an agency, ask for the name of the interpreter who

has been scheduled

• Provide prep material

– Agenda, presentation, list of people attending

• Set up an appropriate environment

– Line of sight, visual access/distractions

– Lighting, glare/reflection from windows

Possible Seating Arrangements

What Next? (DURING)

Do:

• Speak directly to the Deaf person

• Set up the environment

• Speak at a normal pace

• Speak one at a time

• Expect everything you say to be interpreted

• Allow ample time

• Maintain eye contact

• Ask about their personal preferences

• Be patient and positive

Don’t:

• Speak in third person (“Tell her”)

• Speak directly to the interpreter while he/she is working

• Ask the interpreter for information about the Deaf person

• Speak when someone’s hands are up

• Forget that culture is an important element of communication

• Ask the interpreter to not interpret something that was said

When Things Might Be Different (DYSFLUENCY)

• When a person does not have fluency in their own

native language.

– Language Deprivation or lack of exposure to language

– Intellectual Disability/Developmental Disability/Autism

– Rubella, meningitis, etc.

• What are the implications?

– Language Deprivation

Syndrome

– Fund of Information deficits

– Concrete thinking

– Lack of “time stamp”

– Problem solving deficits

– Assessments/diagnoses

skewed

Dysfluency and Interpreting

• How does dysfluency impact interpreting?

– Specially trained interpreter

• Seeking meaning vs Describing language

• Qualified Mental Health Interpreter

– Collaborative Interpreting Process – prep the interpreter

in advance

• Prioritizing effective communication

• Working as a team to reach understanding

• Pre- and post-session with the interpreter to discuss

any language issues that arise

• Be patient! This process can take longer in the

moment, but in the end avoids many pitfalls

What is a Deaf Interpreter (DI)?

• A person who is Deaf or hard of hearing

• Possess excellent communication skills in both American

Sign Language and English

• Has an extensive knowledge and understanding of

deafness, the deaf community, and/or Deaf culture

• Works as a team with a hearing sign language interpreter

• Being a CERTIFIED Deaf Interpreter (CDI) means:

– trained in the role and ethics of interpreting

– has specialized training and/or experience in use of gesture,

mime, props, drawings, home signs, and matching sentence

structure and language development

Using a Certified Deaf Interpreter (CDI)

8/23/2019 61

Infographic

And then? (AFTER)

• Ask Deaf participant(s) how

communication can be improved

• Post-session with interpreter

• Evaluating efficacy; new plan?

• If interpreter was a good fit, ask right then

for future availability to ease scheduling

complications

Interpreting Resources

• ADA Effective Communication clause

www.ada.gov/effective-comm.htm

• Registry of Interpreters for the Deaf, Inc. (RID)

www.rid.org

https://www.rid.org/ethics/code-of-professional-conduct/

rid.org/about-rid/about-interpreting/standard-practice-papers/

• National Association of the Deaf (NAD)

nad.org

www.nad.org/about-us/position-statements/position-statement-on-

mental-health-interpreting-services-with-people-who-are-deaf/

Interpreting Resources

• Office of the Deaf and Hard of Hearing (ODHH)

https://www.dli.pa.gov/Individuals/Disability-

Services/odhh/interpreters/Pages/default.aspx

• Working with an interpreter

https://nilservices.com/working-with-an-asl-interpreter/

• Can You Read My Lips?

https://www.youtube.com/watch?v=n1jLkYyODsc

• Certified Deaf Interpreter (CDI) Information

http://www.handsandvoices.org/articles/misc/V13-

2_interpDiff.htm

Interpreting References

• NAD White Paper

• RID White Paper

• Articles:

– Crump, C., & Glickman, N. (2011). Mental Health

Interpreting with Language Dysfluent Deaf Clients. Journal

of Interpretation, 21(1), 21.

Helpful Tools To Use

Communication Timeline

• Do your research!

• What did communication look like over his/her

lifetime and in different domains of life?

– Did he/she attend a Deaf School?

– Did the family use ASL?

– Age of onset? When did the individual lose his/her

hearing?

– Other diagnoses to consider?

– Sensory considerations?

– Deaf or deaf? Involved in the Deaf culture

community?

8/23/2019

LifeCourse Tools

• Change the conversation around communication!

• Not just about “accommodating”

• Life Trajectory Worksheet & the Integrated

Support Star

Life Trajectory Worksheet

• Life Outcomes NOT Service Outcomes

• What did communication look like over his/her

lifetime and in different domains of life?

• What experiences led

toward a good life?

• What experiences led

toward what they do

not want?

Integrated Support Star

• Not just about service

• Not just ASL and interpreters

• Use the star to reshape how to think about different

kinds of supports

Personal Strengths & Assets

Technology Relationship Based

Community Based Eligibility Specific

Department of Labor and

Industry,

Office for the Deaf and Hard

of Hearing

ra-li-ovr-odhh@pa.gov

Department of Human

Services,

Office of Developmental

Programs,

Special Populations Unit

RA-ODPDeafServices@pa.gov

Thank you!