The Audiogram Doesnt Tell the Whole Story:

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The Audiogram Doesnt Tell the Whole Story

• When Documentation
• Isnt Enough
• Developed by Mary Morrison and Annette Leonard

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PEPNet
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Topical Agenda

• Caveats
• Demographics
• Intake Process
• The Audiogram
• The Hearing Experience
• Models of Disability
• The Service Providers Dilemma
• Student Profiles

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Caveats

• You have some experience providing services to
  Deaf and/or hard of hearing students.
• You are familiar with audiograms and
  documentation of hearing loss.
• You have a number of good ideas to contribute to
  the discussion of this topic.
• You will perhaps leave with more questions than
  answers.

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Demographics Enrollment

• Deaf and Hard of Hearing Students enrolled in
  postsecondary settings

17,000
1990 2001
27,700
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Demographics Distribution
certificate and other training programs (lt 2
year) 4 year colleges and universities 2 year
colleges and community colleges
15
30
55
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Demographics Retention

• Still enrolled
• Certificate
• Associates Degree
• Bachelors Degree
• Withdrew

9 10 4 10 67
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Demographics Retention

• Drop out rate for general college population
  more than 40 (Tinto, 1993)
• Drop out rate for students with a hearing loss
  approximately 70 (Myers Taylor, 2000)

From Smith, J. The Retention of Deaf Students in
Mainstream Colleges
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Intake Process

• How many have specific intake process for Deaf
  and Hard of Hearing students?
• Is that a paper-based questionnaire?
• Do you do conduct a one-on-one intake
  appointment?
• Direct or facilitated communication?
• Do any of you employ a method not mentioned here?

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The Audiogram

• Represents the softest sounds one can hear

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The Audiogram

• X left O right ear
• Normal 0-20 dB
• Mild 20-40 dB
• Moderate 40-70 dB
• Severe 70-90 dB
• Profound 90 dB
• ALL levels have social, academic and vocational
  impacts!

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The Audiogram

• Does
• Give a snapshot of the persons unassisted
  hearing loss
• Satisfy the documentation requirement for
  receiving services

• Does Not
• Tell you what the person functionally hears
• Specify what academic adjustments will be useful
  for the individual

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The Audiogram
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The Hearing Experience

• Wha mi e udent wi a earing lo
  ear? e above image gra ou peech ound
  acro I two dimen ion , requen y ( rom low o
  I acro e op) and oudne ( rom o
  t o oud down e ide). ome peech ound
  are o t and I pi ched ( op and
  right / /,/ /,/ /), o
  er are louder and lower pi ched (/n/, /g/).
  e ound repre ent an average.

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The Hearing Experience

• What might the student with a hearing loss hear?
  The above image graphs out speech sounds across
  its two dimensions, frequency (from low to high
  across the top) and loudness (from soft to loud
  down the side). Some speech sounds are soft and
  high pitched (top and right /s/,/f/,/th/),
  others are louder and lower pitched (/n/, /g/).
  These sounds represent an average.

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The Hearing Experience

• Hearing loss
• binaural or monaural
• severity (dB) and frequency (Hz)
• conductive or sensorineural
• may fluctuate or be progressive
• Age at onset of loss
• Acceptance of loss
• Speech reading and/or signing ability and
  preferences
• Hearing aid/T-coil use
• Identity Deaf, hard of hearing, hearing, etc.

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The Hearing Experience

• What one does not hear plays a larger part in
  defining the hearing experience than what is
  heard
• More is determined by the information that is
  missed than what is received
• Access to family, friends and school i.e. the
  social, academic impact

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The Hearing Experience

• Previous Academic Access Elementary, Junior HS,
  HS, College
• Speech reading
• Assistive Listening Devices
• Interpreters/Transliterators
• Assistive Listening Devices
• Speech-to-Text Service

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Models of Disability

• The Medical Model
• Conceived in the mid 1800s
• Based on medical advances and pathology
• The Social or Human Rights Model
• Conceived in the 1970s
• Based on human rights and defined by individuals
  with disabilities

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Models of Disability

• The Medical Model of Disability
• Focus on the impairment rather than the
  individual
• Individual is disabled because of his/her
  limitations
• Treatment and care are needed
• Power for change resides with the
  professionals/medical community

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Models of Disability

• The Medical Model of Hearing Loss is focused on
  the individuals limitations as the problem

Limited
Broken
Less Than
Impairment
Incompetent
Needy
Disabled
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Models of Disability

• The Social Model of Disability
• Focus on the societys limitations
• Individual is disabled because of the societys
  structures and limitations
• Education and empowerment are needed
• Power for change resides within changing the
  environment, systems and attitudes

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Models of Disability

• The Social Model of Hearing Loss is focused on
  societys limitations as the problem

Institutionalized Oppression
Lack of Useful Education
Barriers
Audism
Impairment
Inaccessible Information
Discrimination In Employment
De-valuing
Prejudice
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Models of Disability

• Examples
• If all sidewalks had curb cuts, individuals who
  use wheelchairs wouldnt have as much difficulty
  getting around town.
• If all airports included visual paging systems,
  deaf and hard of hearing individuals wouldnt
  miss information.

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Models of Disability

• I dream about being in a world where being
  disabled is no big deal. No one considers it a
  tragedy. No one things youre inspiring. No one
  feels sorry for you. What an amazing relief it
  would be to be seen every day as perfectly
  ordinary.
• From Follifson, J. Imperfection is a Beautiful
  Thing

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The Service Providers Dilemma

• The laws and regulations that provide for my work
  are written around an assumption of the Medical
  Model
• The model that helps my clients become empowered
  and more effectively self-advocate are principles
  of the Social Model

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The Service Providers Dilemma

• The individuals responsibility
• The individuals limitation(s)
• Multiple learning environments
• My legal responsibility
• My background and expertise
• Is it my responsibility to help educate and
  provide tools for the individuals
  empowerment?...

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Is it my Responsibility?
If it isnt

• Not obligated to go above and beyond the request
• Less time on the front end
• The individual may still spend a long time
  searching for appropriate academic adjustments

• Reduces the opportunity for success
• The placement or adjustments may not be
  appropriate
• Future detriment
• I dont have to be as educated and informed

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Is it my Responsibility?
If it is

• Demonstrate and/or educate about options
• More time on the front end
• The individual may still spend a long time
  searching for appropriate academic adjustments
• Am I shooting myself in the foot?

• Better opportunity for success
• The individual will learn skills and independence
• Future benefit
• Potential for growth and development
• Supports the Social Model of Disability

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Student Profiles

• Diagnosis severe hearing loss
• Roberta Jean
• Billy Jean
• Jose Jean
• Suzie Jean

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Roberta Jean

• Social Work Major
• Severe Hearing Loss
• Progressive Loss age of onset- 4
• Large metropolitan city
• Aided Bilaterally
• Considers herself Hard of Hearing
• Speech Discrimination Rt-52 Lt-56
• Uses speech reading with family and friends

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Billy Jean

• Pre-med Major
• Severe Hearing Loss
• Age of Onset- Birth
• Large Metropolitan City
• Cochlear Implant- 20 months
• Used Interpreters K-12
• Has hearing friends

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Jose Jean

• Elementary Education Major
• Severe Hearing Loss
• Age of Onset- Birth
• Large metropolitan city
• Parents are Deaf
• Attended Residential School
• Has never used an Interpreter

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Suzie Jean

• Building Maintenance Major
• Severe Hearing Loss
• Age of Onset- Birth (prelingually deaf)
• Mainstreamed- Rural America
• Parents sign a little
• Used Interpreters K-12

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Academic Adjustments

• Preferred mode of communication
• The students hearing experience
• Major of student
• Course content and structure
• Primary Instructor
• Classroom dynamics

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Academic Adjustments
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Intake and Academic Adjustments

• Recommendations
• Do have a specific intake process for Deaf and
  Hard of Hearing students
• If you have a paper-based questionnaire Do
  follow-up with a one-on-one intake appointment
• Do recognize the value of direct communication.
  If it is not possible, develop questions to
  augment facilitated communication.
• Take the time to go and observe what happens in
  the classroom.
• Intake is a process, not an event

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Students Recommendations for Practitioners

• More deaf students!
• More accessibility in and out of classroom
• Closed-captioning
• Extracurricular activities interpreted
• Interpreters and notetakers who are qualified and
  evaluated
• Improved communication with faculty via email
• In-service training for faculty

From Smith, J. The Retention of Deaf Students in
Mainstream Colleges
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Resources

• Dr. Julia Smiths Dissertation Deaf Students in
  Mainstream Colleges http//www.wou.edu/smithj/JS
  dissertation.pdf
• Dr. Smiths PowerPoint The Retention of Deaf
  Students in Mainstream Colleges
  http//wrocc.csun.edu/wsdnotes/Thurs1045-1220Opal
  .ppt
• Annette Leonard, Mary Morrison PowerPoint The
  Audiogram Doesnt Tell the Whole Story When
  Documentation Isnt Enough
• http//www.wou.edu/education/sped/wrocc/audiogram
  intake_files/frame.htm

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For More Information

• Annette Leonard
• Project Director
• WROCC Outreach Site at
• Western Oregon University
• 345 N. Monmouth Avenue
• Monmouth, Oregon 97361
• (541) 346 0639 v/tty
• leonarda_at_wou.edu
• http//www.wou.edu/wrocc

• Mary Morrison
• Project Director
• WROCC Outreach Site at
• The University of Montana
• 634 Eddy St. CHC 031
• Missoula, Montana 59812
• [phone] v/tty
• Mary.morrison_at_mso.umt.edu
• http//wrocc.ruralinstitute.umt.edu/