History of Vocational Rehabilitation Services

The field of deafness rehabilitation has experienced significant progress in recent years. However, little attention, beyond the provision of hearing aids, has been given to the large majority of persons who are classified as hard of hearing and late deafened. Since the mid-1970s, vocational rehabilitation (VR) program development and staff training have focused on accessing culturally deaf and signing persons to its service delivery system. Little attention has been given to service interventions that are needed for non–signing persons who are hard of hearing or late deafened in order for them to persevere through the stresses of hearing loss and the accompanying adjustment process, which must take place to enter or remain in the productive workforce. Often hearing aids are provided while more complex and debilitating problems go undiagnosed and untreated.

There is a growing national awareness that the needs of persons who are hard of hearing and late deafened are very different from the needs of persons who are deaf. The problems are often invisible or seem minor. However, research indicates that many people who are hard of hearing or late deafened are adversely affected by their hearing loss to the point of not being able to function at work, home or in the community. The devastating and debilitating effects of hearing loss are reported be to be one of the leading reasons people in the workforce retire early.

The needs of persons who are hard of hearing and late deafened are often not adequately met by VR agencies. This is largely due to a general lack of both counselor and consumer awareness of the problems unique to these populations, and the menu of communication enhancement practices and services that might be utilized to modify their training and work environments. Although hearing loss is an old problem, knowledge of the significant associated stresses, communication and technology needs for persons who are hard of hearing and late deafened are just starting to be recognized.

In 1991, training modules: Rehabilitation of Individuals who are Hard of Hearing and Late Deafened, and Assessing Service Delivery To Individuals Who Are Hard of Hearing and Late Deafened: A Guide For Agency Administrators, were developed by the University of Arkansas Region VI Rehabilitation Continuing Education Program, and regional train-the-trainer sessions conducted in their use. As a result of that training, a few states applied the recommended assessment model to their programs. They used the assessment results to develop a state specific strategic plan for provision of specialized VR services for this population. They identified and trained counselors in the communication, psychosocial and technology issues and solutions unique to people who are hard of hearing and late deafened. They had very positive, significant and exciting outcomes and were able to document the need for specialized VR programs and counselors for consumers who are hard of hearing and late deafened. Their programs resulted in better employment outcomes for greater numbers of eligible consumers who are hard of hearing and late deafened.

For example, the Kentucky Office of Vocational Rehabilitation completed an assessment of their services for persons with hearing loss using the instrument presented in the 1991 training package described above. The data collected from the assessment identified some problems in service delivery to consumers who are hard of hearing and late deafened. Often the consumer’s preferred mode of communication was not documented, and the functional limitations of the hearing loss or employment impediments were not correctly determined. Another identified area of concern was that hearing aids were often the only technology purchased for these consumers without exploration of additional hearing assistive technology that could have been beneficial to them on the job. After designated staff was provided with specialized training and agency support, services to this population improved significantly. Over the following eight-year period, the percent of consumers who are hard of hearing and late deafened receiving VR services rose from 6 percent to 16 percent of the total population served. There was an almost 300 percent total increase in successful employment outcomes or almost three times as many individuals who are hard of hearing who went to work or maintained their employment. However, the most important measure of success of the completed assessment and strategic plan to improve services is continued consumer satisfaction. To date, Kentucky VR continues to maintain, monitor and improve these services based on the success of this initiative.

In 1992, the Nineteenth Institute on Rehabilitation Issues (IRI), Serving the Underserved- Principles, Practices, and Techniques focused on consumers who are hard of hearing as an underserved disability group and made recommendations for enhanced services to these consumers to the Rehabilitation Services Administration (RSA), state agency administrators, state coordinators of services to the deaf (SCDs), long-term training programs, and regional rehabilitation continuing education programs (RCEPs). One recommendation was that the 1991 University of Arkansas Region VI RCEP training package be updated, expanded and replicated for periodic in-service training and for use in long-term training programs.

In 2000, a Rehabilitation Services Administration Information Memorandum (RSA-IM-0021) further reinforced recommendations from the 19th IRI. It stated, “The document identified the fact that VR counselors are frequently inexperienced and not aware of multiple services that are often needed by individuals who are hard of hearing. The IRI outlined comprehensive information on various services that can be provided to individuals who are hard of hearing to aid those responsible for the provision of VR and related services to this segment of the hearing impaired population.”

In the September/October 2003 issue of Hearing Loss, Hearing Loss Association of America’s magazine, Terry D. Portis stated, “According to our members across the country, yes, there is a problem. We are not satisfied with people simply adding ‘and hard of hearing’ to their names or mission statements and then not providing services and supports for people who are hard of hearing. To be very blunt, this is a misrepresentation and disingenuous. There are reports of agencies and organizations that have no history, no training, no expertise and no focus in services and supports for people who are hard of hearing, yet claim to be serving them.”

In the September/October 2003 issue of Hearing Loss, Hearing Loss Association of America’s magazine, Terry D. Portis stated, “According to our members across the country, yes, there is a problem. We are not satisfied with people simply adding ‘and hard of hearing’ to their names or mission statements and then not providing services and supports for people who are hard of hearing. To be very blunt, this is a misrepresentation and disingenuous. There are reports of agencies and organizations that have no history, no training, no expertise and no focus in services and supports for people who are hard of hearing, yet claim to be serving them.”

In 2008, the fifth edition of the Model State Plan for Vocational Rehabilitation Services to Persons who are Deaf, Deaf Blind, Hard of Hearing, and Late Deafened (The MSP), for the first time, placed an equal emphasis on staffing and provision of services to consumers who are hard of hearing and late deafened.

In the 20 years since the original hard of hearing/ late deafened training package was implemented, the Rehabilitation Act has been reauthorized with new mandates that need to be recognized. Technology and communication options have made dramatic progress. Recognizing the need for a training materials update, the U.S. Department of Education awarded a training project to the Department of Educational Development at the University of Arkansas for Medical Sciences to develop and make available an up-to-date resource for VR professionals who seek more training to improve their service to adults who are hard of hearing and late deafened.

Overall Module Training Objectives

  1. To demonstrate the need for state VR agencies to develop specialized staff and services to meet the unique needs of consumers who are hard of hearing and late deafened.
  2. To increase knowledge, understanding and implications of key issues that impact service delivery to individuals who are hard of hearing and late deafened.
  3. To examine policy and practice compliance with the Rehabilitation Act Amendments of 1998 as it relates to consumers who are hard of hearing and late deafened.
  4. To provide a tool that can be used to assess current agency impact on the rehabilitation and employment needs of consumers who are hard of hearing and late deafened
  5. To provide a model for program strategic plan development that is action and outcome oriented, and based on program assessment findings.
  6. To provide resource materials to assist with assessment and strategic planning.

Intended Use

The purpose of this module is to assist state VR agencies to comply with the mandates and intent of the Rehabilitation Act as related to consumers who are hard of hearing and late deafened. It provides guidelines for assessing an agency’s current level of services for individuals who are hard of hearing and late deafened and targets staffing, personnel development, accessibility, policy and service delivery practices to consider in developing a strategic plan for vocational rehabilitation services for these consumers.

Challenges are addressed that face VR agencies and programs in their efforts to increase and expand services to these underserved populations in areas of identification and outreach, eligibility, order of selection for services, consumer empowerment and participation, policy, case practices, and staff knowledge and skills.

Suggestions and options are presented for organizational structure, staffing, policy, service strategies and strategic planning for improved services and outcomes for consumers who are hard of hearing and late deafened.

In summary, the purpose of this manual is to help answer the following questions concerning VR service delivery to persons who are hard of hearing and late deafened:

The Top 10 Reasons to Assess the VR Program and Services

10. To recognize that consumers who are hard of hearing and late deafened are underserved populations – both in numbers served and in scope of VR services provided.

9. To address unmet service needs advocated by the Hearing Loss Association of America and other consumer sources of input.

8. To provide the same quality of services to consumers who are hard of hearing and late deafened as are provided to other disability groups- to level the playing field- as advocated by the Model State Plan for Vocational Rehabilitation Services to Persons who are Deaf, Deaf-Blind, Hard of Hearing, or Late Deafened.

7. To assist with job advancement and retention, avoid underemployment and avoid early retirement of persons who are hard of hearing and late deafened.

6. To recognize that technology can enhance hearing aids to maximize communication.

5. To comply with the Rehabilitation Act mandate that services must be provided by qualified staff and vendors, and in the consumer’s preferred mode of communication.

4. To ensure that staff and offices are fully accessible to these populations.

3. To provide consumers with knowledge of, and informed choice of, the full range of employment related services they might need to maximize their employment.

2. To train existing counselors to understand the employment needs and service options for consumers who are hard of hearing and late deafened.

And the number one reason is:

1. To assist consumers who are hard of hearing and late deafened to obtain, regain or retain employment consistent with their unique strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice, resulting in optimal employment outcomes and consumer satisfaction.

Are Persons who are Hard of Hearing and Late Deafened Underserved by VR?

The Rehabilitation Act Amendments of 1998 require VR agencies to conduct a comprehensive statewide needs assessment (CSNA) every three years, describing the VR needs of individuals residing in the state. One of the mandated areas to assess is the VR needs of individuals with disabilities who are unserved or underserved by the VR program. The VR Needs Assessment Guide, InfoUse, Berkley, CA, 2009, defines “unserved” as persons who could be eligible for VR services but who are not receiving services, and “underserved” ( should be blue) as persons who are not receiving equal or full benefits of VR.

Consumers who are hard of hearing and late deafened are not generally thought of as “unserved” or underserved populations because VR data indicates that a large number of persons in these disability groups are being served. However, when compared to the general population statistics, it appears that many potentially eligible persons who are hard of hearing and late deafened are not being served. When considering “equal or full benefits,” VR data shows an overwhelming number of eligible consumers who are hard of hearing who are receiving single service hearing aids without consideration to other services of which they are probably in need, and thus would be considered to be underserved. States should therefore make an effort to specifically consider individuals who are hard of hearing and individuals who are late deafened in their triennial comprehensive statewide needs assessment.

Related Mandate:

Section 101(a)(15)(A)- mandates that each state vocational rehabilitation agency, every three years, conduct a comprehensive, statewide needs assessment describing the rehabilitation needs of individuals with disabilities residing within the state. The vocational rehabilitation service needs of individuals with disabilities who have been unserved or underserved by the vocational rehabilitation program is one of the priority areas that is mandated to be addressed.

* “Related Mandates” cited throughout this document refer to the Rehabilitation Act Amendments of 1998.

The 19th Institute of Rehabilitation Issues, Serving the Underserved- Principles, Practices, and Techniques developed a model that could be applied to any underserved group of individuals with disabilities. The model was then applied to persons who are hard of hearing and persons with epilepsy as examples of underserved populations.

Included in the model were the following indicators for identification of “underserved” populations, which apply to many persons who are hard of hearing and late deafened: