CRP Your Source for Issues and Trends in Community Rehabilitation BRIEF May 2007 Vol. 5, No. 2 Trends and Issues Related to Community Rehabilitation and Persons who are Deaf or hard of hearing With the number of individuals with hearing loss growing, the caseload composition of individuals is beginning to change too. Community rehabilitation providers must be prepared to serve these individuals with the most current skill sets. We are pleased to have Dr. Sandra Hansmann and Dr Shawn P Saladin co-authors of this Brief which discusses the current issues and trends. Both are assistant professors in Rehabilitation Studies at the University of Texas—Pan American. BACKGROUND Hearing loss is the most common sensory disability in humans, and the number of individuals with hearing loss is growing (National Research Council, 2005). By the year 2015, an estimated 13 million people in the U.S. will have some hearing disability (Scheetz, 2004). Several key trends and issues are impacting people who are Deaf or hard of hearing and related rehabilitation service providers. Trends in the increasing diversity and aging of the population, along with issues in technology-based treatment and management of hearing loss are especially important in the field today. Additionally, challenges in employment-related service provision continue to affect the Deaf and hard of hearing communities and those who serve them. Diversity While the Deaf or hard of hearing population has always been heterogeneous (Allen, 1994), national trends in population growth are resulting in ever-increasing diversity. In particular, the number of Hispanic-Americans who are Deaf or hard of hearing is increasing as the U.S. Hispanic population grows generally. According to the U.S. Census Bureau, Hispanics account for just over half of the total population growth nationally. Increasing diversity within the Deaf or hard of hearing population will require improvements in multicultural service provision skills and diversification of rehabilitation and related service plans and options. Aging Population The U.S. population is not only becoming more diverse but is also aging, and the “baby boom” generation will soon reach retirement age. While baby boomers are expected to experience less severe disabilities as they age than previous generations, acquired hearing loss remains prevalent among older people. Additionally, the population of Deaf or hard of hearing people is growing older, but little research has yet been conducted on the impact of aging on persons who are prelingually Deaf or otherwise not considered late-deafened. A subgroup of elderly hard of hearing and culturally Deaf individuals is expected to develop, representing challenges and opportunities for consumers and CRPs (Edmondson, 2006). Technology Technologies for sound amplification and communication technologies that are not sound-based have changed greatly in recent years. Rehabilitation options today have dramatically changed with increasing use of cochlear implants and other prosthetic devices and development of communication tools such as Video Relay Services (VRS) and cellular or Internet options such as email and text messaging. In particular, recent research indicates the use of two-way text messaging among Deaf adolescents is increasing independence, self-efficacy, and literacy (Cawthon, 2006), all factors likely to influence future adult services. Employment Related Services Despite the large numbers of Deaf or hard of hearing individuals in the country, there has been a This project is in part supported under a grant from the Department of Education. However, the contents do not necessarily represent the policy of the Department of Education and endorsement by the Federal Government should not be assumed. decline in the number of people who are Deaf/Hard of Hearing and receiving services. Research has demonstrated consumers who are Deaf or hard of hearing receive more basic restoration and interpreting services and less university, business, or vocational training than people in other disability groups, and are more frequently placed in non-paying jobs. Rehabilitation service providers are still often inexperienced and are not always aware of the types of services needed or the differences between medical and cultural definitions of Deafness or hearing loss (Capella, 2003). Improved services to a greater number of consumers would be an appropriate means of reaching both personal and employment goals. IMPLICATIONS FOR CONSUMERS Some of the major issues people who are Deaf or hard of hearing face include isolation related to aging, fewer options in state and federal rehabilitation programs, and unemployment and underemployment. Communication difficulties can result in adult life-induced emotional stresses, which may only increase over time. As people who are Deaf or hard of hearing age, many report a decrease in life satisfaction while feelings of isolation and depression increase (Allen, 1994). However, technological options for the treatment and management of hearing loss are growing, and are vital to physical and mental health of many Deaf or hard of hearing individuals. Aural rehabilitation remains an important treatment and management strategy, encompassing a variety of methodology and technology. Current theory and practice in aural rehabilitation emphasizes speech development, auditory development, and language and communication (Hull, 2001). The use of assistive listening devices is also a key management method, now being augmented by the use of communication tools such as VRS, the Sidekick and similar cellular devices, along with electronic mail and Internet-based chat and instant messaging. Additionally, cochlear implants have become more sophisticated and more accepted in the Deaf community, providing consumers with more access to sound than ever before (National Center for Health Statistics, 2002). Audiological, medical, and psychosocial factors influence cochlear implantation, but many people are good surgical candidates, especially those who do not benefit from conventional hearing aids, who do not have auditory nerve damage, and who are committed to follow up therapy (National Research Council, 2005). In the area of employment, jobs that require frequent interactions with customers or use of the telephone have not traditionally been open to people who are Deaf or hard of hearing, but new communication technologies are now opening doors. Anecdotal reports from the field suggest as more people—both hearing and Deaf or hard of hearing — use e-mail, instant messaging, video phones, and other similar tools, the more the employment playing field is leveled. Various programs provide these technological options, several of which are listed under “Websites & Resources”. Deaf and hard of hearing communities are also being influenced by growing cultural and linguistic diversity, and a number of organizations for Hispanic Deaf consumers and their families now exist, many of which are on-line. The Latino Deaf: Resource Center for Deaf Latinos and Latinas available at http://www.deafvision.net, the Hispanic Deaf Club, founded at the Rochester Institute of Technology at http://www.rit.edu/~hdcwww/, and Signing Fiesta at http://www.signingfiesta.com are just a few examples. Consumer-driven state and national conferences for Hispanic Deaf and hard of hearing individuals are also gaining ground, with the next major conference to be held by the Texas Latino Council of the Deaf and Hard of Hearing this year (TLCDHH; http://www.tlcdhh.org/). RELEVANCE FOR CRPS Trends in aging and diversity will have notable impact on the composition of future caseloads, as more aging individuals and individuals from minority groups seek services. Age-related hearing loss can be multidimensional and include decreased auditory sensitivity, discrimination, and judgment with resultant social, psychological, and communication concerns (Hull, 2001). Aging also often results in increased use of over-the-counter and prescription medications, a number of which have ototoxic effects resulting in sudden deafness or permanent high frequency loss. Thus, caseloads are more likely to include individuals who are late-deafened, and who because of other age-related complications may be less than optimal candidates for either surgical interventions or assistive listening devices. Additionally, serious concerns exist in the provision of rehabilitation and related services to Hispanic Deaf or hard of hearing consumers. Language, culture, and information and service barriers negatively impact Hispanic families with Deaf children (Steinberg, Bain, Li, Delgado, & Ruperto, 2006), and deficits in counseling and guidance, restorative, and job placement services for Hispanic consumers result in fewer successful rehabilitation closures (Moore, 2001). CRPs will need more culturally relevant service provision skills, and will ideally develop trilingual language abilities in ASL, English, and Spanish in order to better serve consumers and their families. Assistive communication technologies are particularly useful options for accommodations across all settings for individuals who are Deaf or hard of hearing. Technologies routinely used by the general public such as web-based chat, electronic mail, or text messaging may also be very useful to people with hearing loss and to service providers. Additional communication technologies have been developed especially for people who are Deaf or hard of hearing, and include text-based telephone relay systems and video relay systems (National Research Council, 2005). Rehabilitation professionals will need greater familiarity with the availability, costs, benefits, and limitations of the latest options, and may also need to increase their own technological skills, especially in the use of instant and text messaging. SUMMARY Trends in diversity, aging, and treatment and management of hearing loss are especially important in the field today; caseload composition is beginning to change, as are best practices in service provision. Addressing issues related to these trends will require development of new knowledge, skill sets, and abilities among consumers and CRPs. The National Association of Area Agencies on Aging notes few U.S. communities have the social programs, care, and facilities needed to be “aging- prepared”, and the Deaf community may lack preparedness for aging members as well. Increasing diversity is also changing the face of the Deaf and hard of hearing population, and trilingual community members and service providers are already in great demand. Technology is further impacting services, especially in the areas of communication and related employment outcomes, and technology- based options should be explored as part of comprehensive rehabilitation planning. Despite challenges encountered by people who are Deaf or hard of hearing and by professionals who serve them, the rehabilitation outlook is bright, and many growth opportunities exist. WEBSITES & RESOURCES The National Association of the Deaf (NAD). http:// www.nad.org The Hearing Loss Association of American (Self Help for Hard of Hearing People-- SHHH). http:// www.shhh.org/ American Deafness and Rehabilitation Association (ADARA). http://www.adara.org/ Sorenson Communications. http://www.sorenson. com/ Harris Communications. http://www.harriscomm. com Laurent Clerc national Deaf Education Center: Resources for Hispanic Deaf and Hard of Hearing Populations. http://infotogo.gallaudet.edu/hispanic. html Lane, H. (1992) The mask of benevolence: Disabling the deaf community. New York: Knopf. Lane, H., Hoffmeister, R., & Bahan, B. (1996). A journey into the deaf world. San Diego, CA: Dawn Sign Press. Padden, C., & Humphries, T. (2005). Inside deaf culture. Cambridge, MA: Harvard University Press. REFERENCES Allen, T. E. (1994). Who are the deaf and hard-of- hearing students leaving high school and entering postsecondary education? Retrieved April 12, 2007 from http://gri.gallaudet.edu/AnnualSurvey/ whodeaf.html Capella, M. E. (2003). Evaluating differences in demographics, services, and outcomes for vocational rehabilitation consumers with hearing loss versus consumers with other disabilities. Journal of Rehabilitation, 69(3), 39-46. Cawthon, S. W. (2006). National survey of accommodations and alternate assessments for students who are Deaf or hard of hearing in the United States. Journal of Deaf Studies and Deaf Education, 11(3), 337-359. Edmondson, B. (2006). Demographic change and low-literacy Americans. In J. Comings, B. Garner, & C. Smith (Eds.), Review of adult learning and literacy: connecting research, policy, and practice: Vol. 6 (pp. 19-41). Mahwah, NJ: Lawrence Erlbaum Associates Publishers. Hull, R. H. (2001). What is aural rehabilitation? In R. H. Hull (Ed.), Aural rehabilitation: serving children and adults (4th ed., pp. 3-17). New York: Singular. Moore, C. L. (2001) Racial and ethnic members of under-represented groups with hearing loss and VR services: explaining the disparity in closure success rates. Journal of Applied Rehabilitation Counseling, 32(1), 15-23. National Center for Health Statistics. (2002). Trends and differential use of assistive technology devices: United States, 1994. Washington, DC: Author. National Research Council. (2005). Hearing loss: Determining eligibility for social security benefits. Robert A. Dobie & Susan B. Van Hemel, (Eds.) Committee on Disability Determination for Individuals with Hearing Impairments. Washington, DC: The National Academies Press. Scheetz, N. A. (2004). Psychosocial aspects of deafness. New York: Allyn & Bacon. Steinberg, A., Bain, L., Li, Y., Delgado, G., & Ruperto, V. (2003). Decisions Hispanic families make after the identification of deafness. Journal of Deaf Studies and Deaf Education, 8(3), 291-314. Region VI CRP-RCEP PO Box 311456 Denton, TX 76203-1456 Meeting the continuing education needs of community rehabilitation providers Visit Our Website The CRP Brief is published 3 times a year by the Region VI CRP-RCEP and is also available on our website: www.crp.unt.edu For more information contact: Linda Holloway & Martha Garber, Co-editors, University of North Texas - Region VI CRP-RCEP PO Box 311456, Denton, TX 76203-1456 940/565-4000