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:
- Many students who are hard of hearing are not “classified” or identified through the Special Education system.
- A person who is hard of hearing or late deafened may hide the hearing loss because of fear of loss of job, friendships, etc.
- A person who is hard of hearing or late deafened may not realize that his or her employment problems, i.e. stress, fatigue, etc., are a result of the hearing loss.
- A person who is hard of hearing or late deafened may not know that there are ways that he or she can be helped.
- A person who is hard of hearing or late deafened may not know about VR services that could be available to them beyond hearing aid provision.
- Few medical, social, educational or other rehabilitation professionals are trained to recognize and understand the impediments that can stem from hearing disability and therefore fail to refer.
- Many physicians and other professionals do not know about VR and tell persons who are hard of hearing or late deafened, “You just have to live with it. There is nothing you can do.”
- Persons who are hard of hearing or late deafened may not admit or acknowledge their loss due to their own or others preconceived ideas about the stigma of hearing loss.
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.
- Frequently misunderstanding words, i.e. “wash” for “watch”
- Asking people to repeat often
- Responding inappropriately to what is said
- Exhibiting an inability to understand in group situations
- Having difficulty understanding on the telephone
- Intently watching the speaker’s mouth
- Blaming people for not speaking clearly
- Becoming defensive about communication problems
- Turning the head to one side to hear what is said
- Showing strained alertness around the eyes
- Wearing a puzzled expression
- Using a loud voice when speaking
- Speaking barely audible
- Avoiding social situations
- Turning the television or radio volume too high
- Smiling and pretending to understand what is said when it is obvious he or she did not understand
- Relying on significant others or family members to answer questions or respond in communication situations
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.
- Secondary schools: hearing disabled and mainstream programs and teachers, guidance counselors, nurses, and school audiologists
- Postsecondary schools and programs: faculty, other instructors, staff and student access center personnel
- Health care agencies/programs, including physicians, nurses, audiologists, speech/language pathologists, hospitals/clinics, and mental health centers
- Hearing aid and assistive technology dispensers
- Community service centers that serve individuals who are deaf and hard of hearing
- WIA one-stop career centers
- Independent living centers and community rehabilitation centers that serve individuals with all types of disabilities
- Employers, human resource personnel and employee assistance programs (acquired hearing loss often occurs in adults who are currently employed and begin experiencing problems on the job requiring VR assistance to maintain employment)
- Unions, state employment agencies and other work related organizations
- Hearing Loss Association of America (HLAA) and the Association of Late Deafened Adults (ALDA) national organizations and local chapters
- Civic organizations
- State commissions for deaf and hard of hearing
- Current and former VR consumers who are hard of hearing or late deafened
- Professional groups such as state chapters of the Speech, Language and Hearing Association and state chapters of hearing aid dispensers
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.
- The counselor should begin by addressing communication needs of the individual, making sure to put the person at ease about expressing his or her specific communication preferences and needs and the counselor’s willingness to accommodate these needs.
- The counselor should follow guidelines for effective communication.
- Since assessment of need and provision of rehabilitation technology is required throughout the vocational rehabilitation process, the counselor should have basic assistive listening devices and other technology available for the consumer to use, i.e. pocket talker, FM systems, laptop computer for typing, etc.
- Communication strategies should be utilized as needed, i.e. having the consumer repeat back important information to ensure understanding.
- The counselor should instill confidence in the consumer that the counselor is knowledgeable about hearing disability, especially as it relates to employment issues.
- The counselor needs to be sure that the individual has an understanding of the goals and functions of the VR agency, and should give an overview of potential services available to individuals with hearing disabilities, i.e. provision of assistive listening devices (ALDs) to assist in training and on the job.
- The counselor must interview the consumer in depth to establish what services are being sought and to determine if there may be other services in lieu of or in addition to those requested that could be of employment benefit to the consumer.
- The counselor must conduct a thorough inventory of the individual’s disability – including etiology, emotional and functional impact of the hearing disability on the consumer, as well as the perceived impact on individuals who are in frequent contact with the consumer.
- The counselor must consider the overall needs of the applicant in the different stages of employment: preparation (transitioning, training, retraining); job/search/placement; job accommodations; and maintenance of employment.
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:
- Nature and level of hearing loss
- Expressive and receptive communication ability
- Communication mode preference
- Communication functioning in various environments, such as one-to-one, small and large groups, telephone, classrooms, social environments and home surroundings
- Family, work and social relationships
- Cultural affiliations
- Knowledge of hearing assistive technology and abilities for using technology
- Knowledge of, and acceptance of, their hearing disability
- Insight into physical and psychological ramifications of the hearing loss
- Insight into impacts of hearing to the job and associated environmental solutions
- Attitudes toward self-advocacy
- Knowledge of self-help groups
- Levels of support and understanding from family and significant others
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:
- Unsuccessful communication – frustration because he or she cannot understand the counselor
- Misunderstood directions for application, counseling and follow-up appointments
- False expectations of what the counselor/VR agency can provide
- Lack of agreement with the counselor/decision and/or recommendations
- Lack of firm commitment from the consumer for follow through with appointments because consumer does not fully understand the need for the appointment
- Lack of feeling of partnership and choice in planning
- Fear that employer will be informed and/or unaccepting of hearing disability
- Lack of understanding on the part of the consumer regarding the overall impact of his or her hearing disability