3 – Referral and Application

Referral: Identifying the Consumer Who is Hard of Hearing or Late Deafened

Individuals who are hard of hearing or late deafened, and who may benefit from the provision of VR services, are not always easy to find. This may be due to the following:

It is important to note that hearing loss is a potential unidentified secondary disability in persons seeking or already receiving VR services for other disabling conditions. The VR counselor should therefore observe and be aware of communication behavior in all consumers, regardless of presenting disability. When a hearing loss is identified as an additional disability, the VR counselor may discover that the communication and other functional limitations will warrant that this becomes the major disability affecting functional capacity and employment. Regardless of major disability designation, it is important that the consumer who is hard of hearing or late deafened be served by a VR counselor skilled and knowledgeable about the hearing disability.

The following is a list of major indicators that hearing loss may be present. When a person exhibits several of these behavioral signs, it is quite likely that an audiological evaluation will reveal a hearing problem. The signs and symptoms will vary from person to person depending upon the degree and type of hearing loss and the nature of the communication situation.

Referral Development

Transition Services

VR agencies should promote outreach to all students with hearing loss in secondary school programs, those being served under an Individual Education Plan (IEP) or 504 plan, as well as those without any special identification in the education system. Many states have transition programs and counselors who are the point of contact with the school to the VR system. These transition counselors must be trained to recognize the hard of hearing students who have not self-identified and have not been identified by the school, and therefore are falling through the cracks. The transition counselor should transfer the hard of hearing or late deafened referrals to Rehabilitation Counselors for the Hard of Hearing/Late Deafened (RC/HH/LD) or “communication specialists” if such a position exists. If they retain these students in their caseload, they should be trained in related communication and other issues needed to appropriately serve these students.

The Currently Employed Applicant

It is important to note that consumers who experience adult onset hearing loss often have been employed for a number of years before problems on the job due to the hearing loss reach a “crisis” point and timely and effective intervention is needed to maintain employment. If the VR counselor can reach the employee who is hard of hearing and having difficulties as soon as possible and expedite the application process, services may be provided to enable the consumer to keep the job. This result is preferable to having the individual lose the job and then being referred to VR to start from square-one to obtain employment.

Referral Sources

Following are some potential sources of appropriate referrals that the counselor should consider, cultivate and educate to the services that might be available for potential consumers who are hard of hearing or late deafened. These programs may or may not be aware of underlying/hidden secondary or other disabilities of hearing loss in consumers they serve.

Application and Assessment for VR Services

The Initial Interview

The initial interview is crucial in gathering data and information to document the presence of the hearing loss on which eligibility will be based. At this time the counselor can learn what existing medical and other evaluations are available and determine if additional evaluations will need to be authorized to make a timely eligibility decision.

To establish an effective counseling relationship, the counselor and consumer together must immediately determine the communication strategies that work best for each to be understood. In some cases, the consumer will be aware of his or her needs. In other cases, the counselor may need to identify communication problems and model effective communications methods.

At the time of the initial interview, steps must be taken to reduce both consumer and counselor anxiety. The counselor must establish credibility by demonstrating sensitivity to and knowledge about hearing disability and how it can impact the overall functioning of an individual.

Documentation of Disability

The Rehab Act mandate to make eligibility decisions quickly – and to the extent possible, using existing information – makes it essential that the counselor determine specifically what information must be accessed in order to make a fair appraisal of the severity of the employment impediment and the substantiality of services the consumer needs. It is therefore extremely important that the counselor knows what to look for and what questions to ask.

The importance of the initial interview cannot be understated. This is when the counselor/ consumer relationship is established and when the counselor gets a feel for the consumer’s:

Additional formalized instruments may be helpful if the consumer is unaware and/or unable to express specifically how the disability affects the various aspects of their life. Structured questions can be valuable tools for opening the consumer’s eyes to what is actually happening in everyday life activities as a result of problems with the hearing loss and will provide substantial information to the counselor about functional limitations. Formalized assessment tools are also available for this purpose.

Preventing an Unnecessary/Premature Closure

Having at least one assigned person in each VR office who is trained in the vocational rehabilitation of hard of hearing or late deafened individuals, who has associated communication skills and available hearing assistive technology (HAT), will encourage these individuals to work with the VR agency toward successful rehabilitation.

Some of the reasons consumers who are hard of hearing and late deafened fail to follow through with services include: