An Ongoing Challenge to our Systems: Students and Adults

1. An Ongoing Challenge to our Systems: Students and Adults Identified as Low Functioning and Deaf or Hard of Hearing

2. As A Deafness Professional, Most Likely, Some of the People You Serve Are NOT Able To . . . • Participate fully in their educational program • Take advantage of new technologies • Understand the certified NAD/RID interpreter; or • Participate in post-secondary and vocational training opportunities • WHY?

3. Graduation Rates (RRTC-31 in 1980s) • 7,800 deaf & hard of hearing students graduate or exit school each year • 2,300 have 6th to 12th grade literacy skills • Benefit from post-secondary training through accommodations provided in colleges & universities • 3,500 have 2nd to 4th grade literacy skills • Benefit from vocational training through accommodations provided in technical schools and other training programs • 2,000 have less than 2nd grade literacy skills • Accommodations and environmental supports are usually not available to this population

4. More on Graduation Rates • 1996 study indicates that: • 48% of students left school without a diploma • 40% of students received high school diploma • Number to receive diplomas are declining as a result of accountability requirements in No Child Left Behind Act

5. National Longitudinal Transition Study (1987 – 1993) • Reported on deaf students who had been out of secondary school for up to three years as of 1990. • 28% enrolled in postsecondary programs • 20% enrolled in vocational programs • 25% employed in competitive settings • Where’s the other 27%?

6. Gallaudet Research Institute 2007 Other Student Characteristics • English Language Learners 23% • Economically Disadvantaged 37% • Pre-lingual Deaf 56% • Second Disability 40% • Three or More Disabilities 15%

7. What does this mean for Students? • Each year, about 30% of “hearing impaired” students actually graduate • About 30% receive certificate of completion • Many who don’t receive a certificate of completion, have 2nd grade or less literacy skills • 27% of the students who left high school, are NOT working, in college or in voc training

8. What does this mean for Adults? • 60% of people, who are deaf or hard of hearing, are between 21 and 65; i.e.,working age • 60% of the working age group are not in the labor force – they are unemployed

9. Description • Group of individuals within the general population of persons who are Deaf or Hard of Hearing, whose skills and competencies are significantly below average • No precise “epidemiological” description of this group • Individual is a person with a significant disability

10. Labels • Under Achieving • Multiply Handicapped • Severely Disabled • Minimal Language Skills • Traditionally Underserved • Hard to Serve • Low Functioning • Most At Risk • Deaf with Special Needs

11. Definitions Federal Definition: Low Functioning • Individual is Deaf or Hard of Hearing • Individual may have other disabilities • Functioning level prohibits participation in post-secondary education or training • Language and communication are extremely limited • Limited work skills and poor employment history

12. COED Definition • Low functioning adults who are deaf or hard of hearing are an un-served subgroup within the population…due to communication barriers these persons are not able to benefit from conventional rehabilitation training programs. Language limitations may preclude the use of Interpreters…the cost from extended service needs tends to discourage the provision of these services

13. RRTC-1993 Revisions • Incorporated the COED - underserved • Introduction of Risk Factors

14. Risk Factors • Low socioeconomic status • Inappropriate diagnosis • Foreign born or English as 2nd language • Lack of access to services • Lack of family support • Substance abuse • Secondary disabilities • Minority status • Residence in rural/low income urban settings

15. Characteristics of the Population • Inadequate communication skills • Vocational deficiencies • Deficiencies in behavioral, emotional & social adjustment • Independent living skills deficiencies • Educational & transitional deficiencies • Health, mental, and physical limitations

16. Consequential Difficulties • Limited communication abilities • Difficulty in maintaining employment • Poor social and emotional skills • Need support and/or training to live independently

17. Dual “Pathway” to Identification • Medical/Secondary Disability Based • Environmental- Deprivation /Risk Based

18. Diagnosis Errors • Failure to Identify Hearing Difficulty • Identification of Hearing Difficulty as a Developmental Disability • Delayed Identification of Hearing Difficulty

19. Medical / Disability Based Etiology • Undiagnosed Cognitive Barrier • Progressive Sensory Disability • Acquired Physical Barrier • Undiagnosed Developmental Issue

20. Prevalence of Persons with Additional Disabilities • Approximately 6,047,910 of the 20,295,000 who are Hard of Hearing have an additional disability • Approximately 164,496 of the 552,000 who are Deaf have an additional disability • School age data suggest 40% have a second disability • Additional Disabilities Affect Skill Development

21. Deprivation as an Etiology • Inadequate environmental opportunity • Barriers to language acquisition • Barriers to skill acquisition and development • Cumulative impact of lack of opportunity to develop skills

22. Educational Deprivation • Language Development • Reading Achievement • Writing Achievement • Math Achievement • Results from inappropriate placement and lack of resources • Primary Disability Focus

23. Other Deprivation Factors • Inadequate Social Opportunity/Isolation • Inadequate Community Interaction • Inadequate Economic Opportunity • Inadequate Vocational Exposure • Language Deprivation • Inadequate Service Access

24. CRITICAL BARRIER-- COMMUNICATION

25. Language and Communication • Internal: Language is a means of thinking or reasoning • External: Language is a means of communication • Language uses structure/system, rules/grammar and symbols/vocabulary to accomplish internal and external tasks

26. Language Assessment Considerations • Language is symbolic and generative and not easy to assess • Language is synergistic: measurement of one part does not measure the whole • Language is part of the total experience of the individual-difficult to assess in isolation • Language use (quality and quantity) varies according to the setting, inter-actors and topic.

27. Communication and Language Assessment Content • Understanding communicative intentions • Convey information • Express attitude/emotion • Regulation of social interaction • Turn taking • Topic Maintenance • Presupposition and Narrative Skills

28. Language & Communication “Impairments” • ASL: Individual has ASL Signs but lacks understanding of grammar and structure • Communication: Individual has limited pragmatic skills • Lacks “Mother Tongue”: Individual did not have the opportunity to develop a first language and as a consequence is in a state of “language deprivation”

29. Strategies for Communication • Certified Interpreters • Certified Deaf Interpreters • Communication Interveners/Support Support Service Providers • Professionals with ASL Skills • Paraprofessionals with ASL Skills • Family Members

30. Communication Standard • Direct communication is the most effective method between the person who is labeled as either low functioning and deaf or at risk of being low functioning and the service provider.

31. A DISCUSSION OF ASSESSMENT PRINCIPLES AND STRATEGIES (That is, what environmental and social supports does this individual need?)

32. Assessment Of Persons At Risk • Assessment Model • Assessment Principles • Assessment Strategies • Assessment Adjustments • Risk Analysis • Functional Process

33. Bio-psycho-social Model Of Disability • International Classification of Functioning, Disability and Health (ICF) • Replaces Medical Focus • Emphasis on Interaction with Environment NOT Cause and Treatment • Focus on Enhancing Functioning • Focus on Participation • Focus on Environmental Modification

34. Assessment Principles • The ultimate goal is to focus on the interaction of the individual with the environment where he/she is expected to function. • The interaction with the environment will identify the needs for ongoing supports or adaptations to reduce the barriers to optimal functioning.

35. Assessment Considerations: Individual Learning Styles • Field Sensitive Style • Field Independent Style • Ability To Generalize • Need for Learning Support

36. Assessment Considerations: Cultural Awareness • Recognize Cultural Influence • Learn about that influence • Clarify values • Develop fluency in the culture

37. Assessment Considerations: Family Interaction • Improve Competence with Families • Identify Perspective: Needs, Strengths, Priorities and Values • Family and Individual Help Define the Nature of the Assessment • Diversity WITHIN a Culture is Respected

38. Identification / “Assessment” of Persons “AT RISK” of LFD • Hearing Loss/ Deafness is Documented • Secondary Disability is Documented • Screening for Risk Factors in the Individual History • Assessments of Abilities in Functional Domains

39. Risk Factor Screening and Assessment • Low SES-Income < 200% Poverty • Late Diagnosis-Individual > 5 years • Inappropriate Diagnosis- Developmental Disability • Poor Service Access- Lack of medical/social services for adjusting to deafness

40. Risk Factor Screening/ Assessment • Lack of Appropriate Education- No specialized services, education as person with Developmental Disability, began education after age 6 or did not complete at least 12 years of education • Foreign Born- Immigration from a country that lacks appropriate education/ social, medical services

41. Risk Factor Screening/ Assessment • Family Language- English not spoken at home • Minority Status- Risk of lack of access to services because of discrimination • Rural- Low income, limited health education and social services

42. Risk Factor Screening/ Assessment Family Risk Poor or no work history Substance abuse Family involvement w/ protective services Parent incarcerated or w/ arrest record Involvement with social welfare agency Receives public assistance

43. Functional Assessments • Self Care – Situational assessment • Language – Assess grammar and pragmatic use of first language • Communication – Standard assessment of common communication disorders or assessment of a consistent system used for pragmatic purposes

44. Functional Assessments • Literacy – Educational achievement (less than second grade level) • Social Skills – Deficit in interacting in varied settings; poor understanding / differentiation of social role of self and others

45. Functional Assessments • Employment – Interest, aptitude, ability with ecological and situational assessment • Daily Living – Understanding “life routine” of home, money, food, medical • Self-direction – Capacity within the range of choice and preference to decision making

46. Emphasis on Interaction with Environment • The ultimate goal is to focus on the interaction of the individual with the environment where he/she is expected to function. • The interaction with the environment will identify the needs for ongoing supports or adaptations to reduce the barriers for optimal functioning

47. Unmet Needs of Individuals Identified As...At Risk of Being “Low Functioning Deaf”

48. Educational Issues • Personnel shortages and requirement that IDEA service have certified providers • Resource limitations and the establishment of “benefit” for auditory intervention services to be provided • Primary “Disability” identification does not fully describe the complexity of the educational needs • Limitation of Resources that often requires a forced choice between language intervention and auditory intervention services

49. Transition Issues • Family Involvement • Timing and Quality of Transition Plans • Indicator 13: Student Led IEP Challenges • Dispersion of Students into Mainstream Programs-Challenge to Identification • Reduced Resources in the Vocational Rehabilitation Program • Emphasis of Services for high achieving students • Residential Services and wait lists

50. Service Issues • Poor epidemiological Information • Interaction of language and learning: limited research • Poor correlation of diagnosis (needs) with treatment (program plan) and outcomes • Limited funding • Personnel shortage • Systems barriers