Improving Rehabilitation Outcomes with Low Functioning Atrisk Deaf Consumers

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Improving Rehabilitation Outcomes with Low
FunctioningAt-risk Deaf Consumers

• Douglas Watson, Ph.D.
• Presented at
• University of Missouri RCEP
• Region VII Conference on
• Issues in Deafness Deaf Blindness
• Kansas City, Mo
• September, 2006

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Agenda

• Many deaf people at risk of being left behind
• Calls for person-centered planning case
  management
• Effective community-based job training needed
• Job coaching and workplace supports that work
• Evaluative research findings Future directions
• PAR discussion, input and recommendations

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Statistics

• 29.6 million with hearing loss
• 552,00 individuals are deaf
• 165,000 individuals who are deaf have an
  additional disability

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Description of Those Most At-Risk . . .

• Group of individuals within the general
  population of persons who are Deaf or Hard of
  Hearing, whose skills and competencies are
  significantly below average (e.g. less than 2nd
  grade literacy skills)
• No precise epidemiological description
• Estimates of the population
• 125,000 to 165,000

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Labels For Those At-Risk . . .

• Under Achieving
• Multiply Handicapped
• Severely Disabled
• Minimal Language Skills
• Traditionally Underserved
• Low Functioning
• Most At Risk

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Possible Risk Factors Leading to Being At-Risk

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

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Key Characteristics of Population

• Limitations
• Communication
• Vocational
• Educational and transitional
• Behavioral, emotional, and social adjustment
• Independent living
• Health, mental, and physical

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Education Outcome Data

• 28-36 of deaf students have an additional
  educationally-significant disability
• Only 40 of high school leavers read at or above
  4th grade level 15 read at 6th grade level
• Many of these individuals age out and do not
  graduate from secondary education

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Resources for LFD Studentsin Transition to
Work?

• Few available and under-funded resources
• Most resources available are focused on services
  to youth who can participate in postsecondary
  training education programs
• Comparisons of resources allocated
• Average high school student in special education
  cost per year 50,000 - 70,000
• Average postsecondary training for a student per
  year 15,000 (for tuition)
• Average resources for a student labeled as LFD
  per year 2,500 to 6,000

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Lack of Resources Programs for LFD Adults

• Funding for services is inconsistent
• Lack of single program or funding source
• Limitations on program funding eligibility
• Some eligible for SSA, Medicaid, Title XIX
• No federal funding
• No parallel system of financing similar to post-
  secondary programs (federal, state local
  governments)
• Programs not available in most places

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Continued Lack of Resources

• VR administered as 80 different state programs
• Emphasis on short term placement
• VR fee for services insufficient for training
  needed
• ILCs not equipped to serve this population
• Interpreters are NOT effective communication
  access
• Chronic shortage of services staff who have the
  language expertise and KSAs necessary to serve
  persons who do not use standard ASL

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These Individuals Need Environmental Supports
Services . . .

• Comprehensive services training
• Work evaluations
• Job coaching for on the job training support
• Job Placement follow-up
• Independent living skills training
• Survival literacy training
• Transportation training
• On-going work place supports
• Other supports, like on-going Life Coaching
• Most of all communication linguistic access

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Parallel Issue

• Misguided assumption that full access to services
  and support can be provided by sign language
  interpreters
• Most often, youth adults who are LFD require
  direct communication access with service
  personnel for all services supports

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Common System Failure

• Inadequate or no environmental supports are
  provided for
• Employment settings
• Independence at home and in the community
• Access to appropriate life-long educational and
  vocational training opportunities
• Socialization and recreational opportunities with
  peers
• Health care
• Behavioral adjustment and mental health
  counseling
• Accommodations to secondary disabilities

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What is Needed to Adequately Serve?

• Wide range of services
• Acceptable quality service level
• Continuing availability delivery of services
• Efficiency with consortium of agencies
• Meet needs of similar populations in other
  geographical areas

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RT-31 Collaborative Research withKentucky State
VR Agency

• Four regional Deaf/Deaf-Blind Coordinators
• Work with RCDs in region and report to SCD
• Receive advice guidance from interagency team
• Serve consumers who are Deaf-Blind or Deaf-at
  risk
• Use Personal Futures Planning (PFP), or
• Planning Alternative Tomorrows with Hope (PATH)
• Find using PFP process particularly effective for
  planning transition from school to work

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Person-Centered Planning for LFD

• Proven effective as an evaluation planning tool
• Determines needed services and scope of services
• Focuses on interests, preferences abilities of
  individual
• Develops a vision and commitment to action to
  enable the individuals exercise of choice of
  participation in own interests
• Assures services are based on persons needs and
  preferences
• Facilitated by a PFP coordinator when possible
  and by CRP vendor when appropriate

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Person-Centered Transition Plans

• Changing livesOne step at a time
• Best results occur if process begun prior to
  student leaving school
• Can help identify issues priorities for student
• Can help break the cycle of failure
• Can enhance the students chances of success
• Fosters a forum for people to think beyond what
  is available to what is needed..places hope in
  people versus hope in the system

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RT-31 Collaborative Research withLexington
Supported Employment Job Coach Program
PROGRAM FUNDING

• New York
• 5 Boroughs of NYC and Westchester
• VR Funded
• Changed from contract to fee for service.

• New Jersey
• VR Funded
• Fee for service.

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Program Structure
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Consumers Served

• Consumers are Deaf or HOH
• Many have secondary disabilities
• MR/DD
• MH
• Visually Impaired
• Reading levels below 4th grade.
• NY 275 placed with ongoing support
• NJ - 150 placed with ongoing support

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Pre-Employment Phase
Job Search

• NY
• 40 Consumers
• 2 Job Developers
• NJ
• 25 Consumers
• 3 Job Developers

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Pre-Employment Workshops

• Interview prep role play
• Newspaper groups
• Remedial English / Math / R.E.A.L.
• Culture (American Deaf)
• Use of TTY, Alarm Clock, FAX, Video Relay, etc.
• Dress code.
• Meetings - One-on-One groups.

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Job Coaching
THE KEY TO SUCCESSFUL SHORT AND LONG TERM SUPPORT

• 17 full time job coaches / 12 hourly job coaches.
• Backgrounds business, theatre, social work,
  rehabilitation, interpreting, etc.
• At least an Advanced SCPI rating.
• Consumers Employers both depend on job coaches.
• Job coaches go to staff, union and HR meetings.

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From Placement to Long Term Support

• Job Development, interview, placement.
• Intensive Phase (job coach goes daily).
• Eventually of visits decrease.
• 2 months later Extended Phase (2 visits per
  month ongoing).
• 90 days later REHAB!
• Open-ended follow along and support essential.

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JOBS JOBS JOBS
500 Successful Placements

• Hotels (laundry room, catering, food service),
  messenger, mailroom, retail clothing,
  maintenance, home depot.
• Full Benefits
• Some union jobs.
• Salaries 8.00 - 15.00 / hour.

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Additional Services
How to maintain employment, motivation, career
advancement.

• The role of Mental Health services.
• The role of Independent Living Services.
• Pre-employment
• Post-employment

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Service Delivery Support

• Ongoing team meetings.
• Job Coach weekly supervision.
• Client reviews/ case conferences.
• Daily staff support (pagers / email / cell
  phones).
• Monthly staff development trainings.

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Research Questions

• What do job coaches do?
• Who are the consumers using job coaching
  services?
• What is the impact of job coaching on employment
  outcomes?

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A VISION IS NEEDED

• WHAT WILL OUR MODEL PROGRAM LOOK LIKE?

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Planning for Success A Service Model Serving
Low-Functioning Deaf Youths Adults
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Ensuring access to appropriate and effective
supports and services to assist Low functioning
deaf individuals live and work in the community
of their choice
Model for a National Collaborative Service
Delivery System
Model for a National Collaborative Service
Delivery System for LFD

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National Center

• Establishes national priorities and service
  delivery standards
• Promotes research and data collection
• Provides technical assistance and training to
  service providers
• Coordinates nationwide system of direct services
  and supports

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Regional Centers

• Based on geography and population
• Establishes regional priorities
• Coordinates efforts at state and local level to
  ensure access to services and supports
• Establishes regionally- based Affiliate Network
  of public and private service providers

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Affiliate Network

• Includes a wide variety of public and private
  service providers
• Establishes access to a full range of services
  and supports at the state and local level
• Delivers comprehensive specialized services to
  LFD youth and adults

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Outcome

• Opportunities for at risk, low functioning deaf
  individuals to work and live independently
• in the community of their choice

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Consequences

• Without appropriate environmental and social
  supports, these individuals face daily challenges
  just to survive.
• Their dreams to live independently, to work, and
  to have control of their own lives are not
  achieved.

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GOAL The goal is to design a Service
Delivery Model that will ensure adequate and
effective environmental supports to Deaf,
Deaf-Blind, Hard of Hearing and Late Deafened
Youth Adults most at risk or identified as Low
Functioning to achieve optimal personal
independence in the workplace, in the home, and
in the community of their choice.
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Serving Individuals who are Low-Functioning Deaf
The Institute on Rehabilitation Issues is a tool
for use in training of vocational rehabilitation
counselors. The report contains six chapters.
Chapter One frames considerations for serving the
population. Chapter Two discusses methods of
identifying and assessing these persons. Chapter
Three describes the importance of school-to-work
transition and the roles of family, education,
and other service delivery systems in transition.
Chapter Four advocates the team approach to
achieving employment outcomes. Chapter Five
describes the critical need for qualified staff
to serve these individuals. Chapter Six examines
the need for agency assessment of the quality of
services provided to this population.
Free .pdf download from our website www.uark.edu/d
eafrtc
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Model for a National CollaborativeService
Delivery System

• Serving low functioning deaf youth and adults to
  assist them to be meaningfully employed and
  function independently at home and in the
  community
• Position Paper
• May 17, 2004
• To obtain digital copy
• DWatson_at_uark.edu

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Deaf STAR
Deaf STAR (Supported Training for At
Risk) What is Deaf STAR??? Deaf STAR is an
online forum for personnel from Deafness
Rehabilitation and other Career and Vocational
Training Programs to discuss issues related to
employment and employment related services for
persons who are deaf or hard of hearing. Members
of this forum exchange information regarding
intervention techniques, marketing, assessment,
training and general supports to help improve
employment and rehabilitation outcomes for this
population. (DeafSTAR-subscribe_at_yahoogroups.com)
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RT-31, established in 1981, conducts research and
training designed to enhance the rehabilitation
outcomes of persons who are deaf or hard of
hearing. The Center is primarily funded by the
National Institute on Disability and
Rehabilitation Research (NIDRR), United States
Department of Education.
Contact Us
Douglas Watson dwatson_at_uark.edu
Research Training Center For Persons Who are
Deaf or Hard of Hearing 26 Corporate Hill Dr
Little Rock, AR 72205 Fax [phone] Telepho
ne 501-686-9691 RT-31 Web site
http//www.uark.edu/deafrtc