Audiology on the Job The Audiology and Vocational Rehabilitation partnership Nancy Mascia, Au.D.,CCC-A Alabama Dept of Rehabilitation Dr. Nancy Mascia is an employee of the above organization that provides Vocational Rehabilitation Services John Mascia, Au.D.,CCC-A Alabama Institute for the Deaf and Blind Dr. John Mascia is an employee of the above organization that provides Vocational Rehabilitation Services
The majority of Americans with hearing loss are of working age are we meeting their needs?
How many working adults have hearing loss? 17% of adults age 21-64 years has some degree of hearing loss (NIDCD, 2008) Only 49% of non-institutionalized adults age 21-64 years with hearing disabilities are employed (Cornell Univ. Disability Statistics, 2010) Individuals with severe hearing loss earn $12,000 less per year than individuals with mild hearing loss (BHI, 2007)
How many Deaf/HOH in the US? Kochkin (2004) reported 31.5 million people with hearing difficulty, projecting that this will surpass 40 million through the year 2050. He reported the hearing aid adoption rate to be 23.5%, with 77% satisfied with the hearing aids they use.
A Brief Summary of Estimates for the Size of the Deaf Population in the USA Based on Available Federal Data and Published Research: About 2 to 4 of every 1,000 people in the United States are "functionally deaf," though more than half became deaf relatively late in life; fewer than 1 out of every 1,000 people in the United States became deaf before 18 years of age. However, if people with a severe hearing impairment are included with those who are deaf, then the number is 4 to 10 times higher. That is, anywhere from 9 to 22 out of every 1,000 people have a severe hearing impairment or are deaf. Again, at least half of these people reported their hearing loss after 64 years of age. Finally, if everyone who has any kind of "trouble" with their hearing is included then anywhere from 37 to 140 out of every 1,000 people in the United States have some kind of hearing loss, with a large share being at least 65 years old. From: Gallaudet Univ.
Hearing Loss in the Workplace Hearing loss may result in physical, emotional, behavioral, occupational, and social problems. Hearing loss--even moderate levels--can and often does have major impact on individual s employment status. Workers with hearing loss typically don t tell co-workers and supervisors about hearing loss, fearing potentially jeopardizing their job security and career development. Almost no published information available describing implications of hearing loss on people who work, or intervention strategies that can help these individuals cope and continue to cope at their jobs.
Hearing Loss in the Workplace Where can these workers get help? VOCATIONAL REHABILITATION The Dept of Education, office of Special Education and Rehabilitation Services, provides states with funds for Vocational Rehabilitation programs to provide employment-related services for individuals with disabilities, giving priority to the most significantly disabled. Individuals with sensory impairments are considered to be significantly disabled.
Definition of VR, service description VR provides specialized employment, education-related services and training to assist teens and adults with disabilities in becoming employed
Who is eligible for VR services? Individuals with a mental or physical impairment that is a substantial impediment to employment and must be able to benefit from services in terms of going to work
VR Services include: Educational services Vocational assessment Evaluation and counseling Job training Assistive technology Orientation and mobility training Job placement
Common Difficulties of Deaf/HOH as identified by Rehabilitation Services Administration Inadequate communication skills due to inadequate education and limited family support. Vocational deficiencies due to inadequate educational training experiences during the developmental years and changes in personal and work situations during adulthood Deficiencies in behavioral, emotional, and social adjustment. Independent living skills deficiencies. Educational and transitional deficiencies. Health, mental, and physical limitations
Statistics on Deaf/HOH reading level, high school diploma, etc Lack of access to knowledge and skills 86.3% of D/HOH students are educated in the public schools (US Dept of Education, 2012.) 44% of individuals with severe to profound hearing loss did not graduate high school (Blanchfield, Feldman, Dunbar and Gardner, 2001.) (general hearing impaired population, 30.6% did not graduate, from 2001 Dept of Education statistics.) Median reading level of deaf and hard of hearing individuals? No current data available. Data from 2009 continues to suggest 4 th grade reading level and lower for those with severe to profound hearing loss, with higher percentages for children with less severe. Data does not reflect well the impact of CI since the year 2000.
Vocational rehabilitation focuses on: Educational history Employment history reading/writing status communication ability/needs psychological status neurological/cognitive status Presence of other disabilities
What do VRS for deaf/hoh include? Assessment: educational, psychological, vocational Individualized Plan for Employment (IPE) Counseling and Guidance Physical and Mental Restoration: hearing aids, assistive devices, cochlear implants Interpreter services Vocational Training Placement and Follow Up Post-employment Services
When should Audiologists refer to VR? Deaf/HOH individual needs additional support services, is employed or has a goal for employment, and is age 16 years or older Individual needs financial support for hearing aids/assistive technology/cochlear implants that will impact vocational goals
Functionally, individuals with hearing loss are defined by VR as: Hard of hearing: individuals communicate orally by speaking and listening Deaf: individuals communicate using sign language and are part of Deaf Culture
. Variables affecting impact of hearing loss Cause of hearing loss Type of hearing loss Degree of hearing loss patient s age at the onset of hearing loss health Educational history hearing technology history speech/language/reading/writing status communication mode of patient/family/peers psychological status neurological/cognitive status motivation/compliance/acceptance of loss
Role of the Audiologist Improving communication for individuals with hearing loss Assistive Hearing technology to maximize residual hearing Assistive visual technology Informational counseling Communication strategies Auditory training Speechreading/Lipreading
VR relationship with the Audiologist What do audiologists need to know? is the work site hot and humid? Is the work site noisy? Is there equipment (e.g., headphone, gas mask, special vision protection device) that may interfere with the use of a particular style of aid? In all cases the choice of hearing aids must be determined by the requirements of the training or job.
Do Deaf and Hard-of-Hearing Consumers Understand Their Own Technology Needs? Assistive Technology ADA requires the worker to make requests They must be knowledgeable Only 5% of employers denied requests made by employees Deaf/Hard of Hearing workers: Have inadequate assistive technology Do not know better devices to request From ADARA conference, May 2005
Do Deaf and Hard-of-Hearing Consumers Understand Their Own Technology Needs? Assistive Technology 62% of accommodations were NOT appropriate 65% had inappropriate equipment 16% had poor work site awareness of needs 74% wished for different accommodations but were not sure what would be better From ADARA conference, May 2005
Important questions for working Deaf/HOH Adults Hearing Loss and Communication Abilities What is the extent of the individual s hearing loss? Is hearing the only limitation involved? How does the individual communicate with others? Is the individual wearing hearing aids/cochlear implant? Does the individual currently use other types of assistive technology? Does the individual need an interpreter?
Important questions for working Deaf/HOH Adults Specifics about the Occupation and Job Tasks What job tasks are performed and which of the tasks are difficult as a result of the hearing loss? Is background noise an issue in the work environment? (note: even an AC vent over the work space can pose a significant problem) Is communication difficult? What are the potential workplace hazards? What if any accommodations have already been implemented? Is education of supervisory personnel and perhaps coworkers necessary?
Work place evaluation: Functional checklist I. Communication one to one: Supervisor Coworkers Do you attend staff meetings in small or large groups? General public (customers,students,etc) What is your work environment like? (note background noise of people, music and/or equipment, reverberant surfaces such as windows, quieter cubicle environments)
Work place evaluation: Functional checklist II. Telephone communication Can you hear on the telephone with/without hearing aid/ci? Can you hear the telephone ring? is more than one telephone used? is a headset used? can a speaker phone be used? what type of telephone is used? Is use of a cell phone required? does your office use email?
Work place evaluation: Functional checklist III. Environmental alerts/warnings Can you hear fire alarms, smoke detectors, door knocks? Does your workplace use a paging system or closed circuit television for general announcements? What other warning systems are used for weather emergencies, etc?
Work place evaluation: Functional checklist What are the Communication Needs at school or at home? Apply I-III to every situation that will result in work success for the individual Example: vibrating alarm clock so that the individual wakes up on time to get to work Ability to advise supervisor when individual will not be at work that day Accommodations at school to ensure the individual benefits from educational programs
Work place evaluation: Special circumstances Functional checklist Is use of specialized equipment required to perform job tasks? (2 way radios, wireless headsets, stethoscopes, etc.) Is travel necessary on the job?
Assistive Technology for Deaf/HOH Private companies that sell hearing assistive and visual technology receive more orders from VR counselors than audiologists AT recommendations have become more complex given the technology changes in the hearing instrument/cochlear implant industry
Why AT is needed on the job for Deaf/HOH: Facilitate communication Enhance telecommunications Alert to environmental auditory situations
Types of AT for Deaf/HOH Non-auditory Auditory HATS Hearing Assistive Technology
Non-auditory devices Visual displays/captioning Visual telecommunications,tmail/gmail Alerting devices
Technology Options: Visual Communication Devices Computer Assisted Video remote interpreting CART C-Print and Typewell Voice Recognition Visual Displays/Video Captioning UBiDUO/interpretype Voice recognition technology
Alerting devices May use strobe, vibrator, flashing light or signaler with louder sound or lower pitch depending on client need/preference Alerts to: telephone, doorbell, clocks, voice/noise, smoke alarms, weather alert radios A necessity for individuals with severe to profound hearing loss/deafness at home or in the workplace
HATS Option for mild to moderate hearing loss when user is not motivated to use hearing aid initially an ALD can be a good introduction to amplification use situational hearing problems specific to phone, television, conferences significant background noise/distance hearing problems should be considered for individuals with severe to profound hearing loss in addition to hearing aids, especially those that communicate orally.
HATS FM systems Hard wired systems Infrared systems Induction loop systems Bluetooth devices
How can HATS be used with hearing aids/ci? Behind-the-Ear Aid w/telecoil Neckloop Ear Level Speech Processor w/telecoil Silhouette Photos courtesy of Beltone, Oticon, Cochlear Corp, Listen, HATIS
Telecommunications Amplified phones VCO/captioned telephones Video phones Cell phone adapters (HATIS) Text messaging/wireless internet Relay services
Cell phone options How do I use these with a hearing aid? Telecoil/Neckloop Direct audio input HATIS adapters Cell phone amplifiers with or w/o hearing aid Speaker phone Bluetooth adapters
Cellphone Options Silhouette/Neckloop/DAI/amplifier/bluetooth
Is it the technology or is it. expectations Personality non-tech individual Functioning level cultural considerations Comfort zone Other disabilities and/or challenges
Other things to consider Is our consumer adequately coping with the hearing loss? When you work with the VR team, you don t have to handle this alone
Communication management strategies The consumer should know their limitations The consumer should control/manage their environment as well as possible The consumer needs to be assertive Consumer needs Attitude Adjustment (Hearing Journal, May 2007)
Strategies for the listener with hearing aids/assistive technology Avoid Bluffing or pretending to understand, politely ask for repeats or to write key words in bold letters Identify barriers to communication, and develop necessary strategies to overcome these Maintain your hearing aids, molds, and assistive devices If you have difficulty changing or cleaning your hearing aids, have someone show how to do it tactually or with a low vision device like a magnifier (ESPECIALLY IMPORTANT FOR DEAFBLIND) Use your hearing aids consistently to learn to listen
CASE EXAMPLES
CASE EXAMPLES
Additional Questions? Nancy Mascia, Au.D.,CCC-A Nancy.mascia@rehab.alabama.gov (205)290-4406 John Mascia, Au.D.,CCC-A Mascia.john@aidb.state.al.us (256)761-3401 References available on request