supporting deaf or hard of hearing individuals with ......agenda- for our purpose • senses •...
TRANSCRIPT
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)
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• 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)
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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
Department of Human
Services,
Office of Developmental
Programs,
Special Populations Unit
Thank you!