House Concurrent Resolution No. 157, HD1 (1996)

H.C.R. No. 157, HD1, (Appendix A) originally directed the Bureau to:

(1) Consider the creation of a separate vocational rehabilitation branch within the Vocational Rehabilitation and Services to the Blind Division within the Department of Human Services for the deaf and hard of hearing -- similar to the existing branch for the blind; and

(2) Examine a list of seven specific issues relating to vocational rehabilitation services for the deaf and hard of hearing.

The proposed separate branch would ". . . centralize services by including counseling, adjustment, and employment sections . . . and thus provide a more streamlined and efficient service system for deaf and hard of hearing persons."⁽¹⁾ The resolution also suggested that the new branch ". . . could provide more comprehensive services geared specifically for deaf or hard of hearing persons to obtain prevocational skills, higher educational opportunities, adjustment services, vocational skills training, and finally job placement . . . and provide easier access [to these] services."⁽²⁾

However, the final HD1 draft shifted the larger task of considering how to provide more comprehensive services in a more streamlined and efficient manner to deaf and hard of hearing clients, including the possible creation of a separate branch, to the Department of Human Services (DHS). The Bureau was given the supplementary task of examining seven specific vocational rehabilitation issues.

These seven specific issues are:⁽³⁾

"(1) A comparison of the client/staff ratio for blind services in comparison to deaf services;

(2) An identification of the number of deaf and hard of hearing high school students ages 16 and older who will be referred for services from the Vocational Rehabilitation and Services to the Blind Division;

(3) An identification of the gaps in services for deaf and hard of hearing students and ways to fill those gaps, such as having a transition program/counselor at the Hawaii Center for the Deaf and the Blind, underemployment, and support services on the job;

(4) An identification of the need for qualified persons who are deaf or hard of hearing to provide services mentioned thereof;

(5) An identification of the need for staff support for clients placed in jobs;

(6) An identification of the impact on deaf and hard of hearing persons due to the change in service delivery from the Hawaii Services on Deafness to Goodwill; and

(7) An assessment of the need for adjustment services for deaf and hard of hearing persons due to the lack of coping skills to deal with problems that arise."

Consultation

The resolution also directed both the DHS and the Bureau to consult with several service and community groups that are actively involved with the deaf and hard of hearing. A brief description of the backgrounds of these groups follows:

Vocational Rehabilitation and Services for the Blind Division (DVR): The focus of H.C.R. No. 157, HD1, is the deaf and hard of hearing -- and not the blind. However, the resolution requests comparative client/staff ratios for both populations. The state agency providing services for both groups is the Department of Human Services, which operates under chapter 348, Hawaii Revised Statutes.⁽⁴⁾ The DHS has established a Vocational Rehabilitation and Services for the Blind Division, but not a division for the deaf or hard of hearing. It should also be noted that the DHS is required to serve not only the blind and the deaf but also "severely handicapped individuals" including persons disabled as a result of:⁽⁵⁾

". . . amputation, arthritis, blindness, cancer, cerebral palsy, cystic fibrosis, deafness, heart disease, hemiplegia, respiratory or pulmonary dysfunction, mental retardation, mental illness, multiple scleroses, muscular dystrophy, musculoskeletal disorders, neurological disorders, (including stroke and epilepsy), paraplegia, quadriplegia, and other spinal cord conditions, sickle cell anemia, and end-stage renal disease, or another disability or combination of disabilities."

Hawaii State Coordinating Council on Deafness (HSCCD):⁽⁶⁾ The HSCCD derives its mandate from chapter 347D, Hawaii Revised Statutes. Its duties are to:⁽⁷⁾

"(1) Compile information on the deaf, hard-of-hearing, or deaf-blind population;

(2) Advocate for the deaf, hard-of-hearing, or deaf-blind;

(3) Develop and monitor programs for deaf, hard-of-hearing, or deaf-blind persons; and

(4) Act to establish better communication and coordination among public and private agencies concerning access to services by deaf, hard-of-hearing, or deaf-blind persons."

The HSCCD has an additional duty regarding communication access:⁽⁸⁾

"The council shall establish guidelines for the utilization of interpreter or other communication access services by deaf, hard-of-hearing, or deaf-blind persons in state programs and activities, including the qualifications of persons who may receive the services and the qualifications and recommended fee schedule of persons who may provide communication access services. The council shall maintain a list of providers of communication access services and their level of qualification."

According to the HSCCD, its mission is to ". . . ensure that Deaf/hh/db [hard of hearing and deaf-blind] persons in Hawaii enjoy equal rights and status, are treated fairly, and can participate fully in all community programs and services." The HSCCD interacts with consumers and the provider and advocacy agencies listed in the resolution. In the context of pre-vocational and vocational rehabilitation services, the HSCCD perceives its role as:

". . . assist[ing] in monitoring and developing programs for Deaf, Hard-Of-Hearing and Deaf-Blind persons, and provid[ing] consultations and assistance so that better communication, coordination and access are established among the public and private agencies for Deaf, Hard-Of-Hearing and Deaf-Blind persons."

Hawaii Services on Deafness (HSOD):⁽⁹⁾ The HSOD is a nonprofit agency first chartered in 1974 and incorporated in 1976. The HSOD reportedly operates the only sign language interpreter service in Hawaii. It provides American Sign Language (ASL)/English interpreters and interpreters for deaf-blind persons to facilitate communication between the deaf population and hearing individuals, businesses, and organizations. This service is currently available on all islands during normal business hours. The HSOD plans to offer 24-hour emergency interpreter referral by the end of 1996.

In addition, the HSOD operates a program that teaches ASL especially to families with deaf or hard of hearing children so that family members can learn to communicate with each other. The program is endorsed by, and receives curriculum input from, the Hawaii Center for the Deaf and the Blind under the Department of Education. HSOD's ASL program is co-sponsored by the Kapiolani Community College's (KCC) sign language/interpreter training program. (The HSOD also has an in-house intern interpreter program -- in coordination with the KCC's program-- to assist deaf and hard of hearing individuals, especially seniors, with personal interpreting needs such as making telephone calls and reading letters.) The HSOD also provides other communications training including the use of telecommunications devices (TTY), telecommunications relay service, and sign language interpreters. Furthermore, the HSOD provides educational outreach to the deaf and hard of hearing communities on issues relating to deafness, including the rights and responsibilities of equal communications access. The agency is also involved in extensive networking with and referral to other agencies, including emergency physical and mental health care providers, the Judiciary, and a variety of social service organizations serving the deaf and the hard of hearing.

Goodwill Industries of Honolulu, Inc.:⁽¹⁰⁾ Goodwill is a private, nonprofit organization whose mission is to assist persons with disabilities and other special needs to achieve their vocational potential and to maximize their ability to become self-reliant members of the community. Goodwill achieves its mission by helping individuals secure gainful employment in the most appropriate placement and then supporting their efforts on the job to stay employed. The ultimate goal for its clients is self-sufficiency.

Specifically, Goodwill operates occupational skills training programs in automated office skills (general office/clerical), food service, commercial custodial, and general work hardening/work readiness. Goodwill's supported employment program helps individuals with the most severe disabilities to find gainful employment and assists with all other issues related to staying on the job. The Island Career Center assists persons whose limitations are related to low income status to find their own jobs and to learn to successfully achieve their work goals. Goodwill also operates programs that are pre-employment in design. One of these is the adult day program which teaches independent living skills to persons with developmental disabilities or mental retardation. Also, the Partnerships for Community Living assists persons to better access community services. Finally, the Adjustment Services program helps deaf and hard of hearing persons to bridge communication and social barriers to better prepare them to enter the work environment.

Ohana Kokua Ano Kuli (OKAK):⁽¹¹⁾ The OKAK is a local chapter of Self Help for Hard of Hearing People, Inc. and acts as an advocacy and support group for hard of hearing individuals and their families. As such, OKAK does not provide direct services. It publishes a monthly newsletter and holds monthly public meetings and presentations on issues of interest to the hard of hearing community.

Aloha State Association of the Deaf (ASAD):⁽¹²⁾ The ASAD is a nonprofit advocacy group affiliated with the National Association of the Deaf. It serves more than 4,000 deaf and hearing impaired people in Hawaii. The ASAD provides referral services and information and a newsletter to the deaf community and engages in advocacy and support for deaf people's civil rights. Its activities include an annual week-long deaf youth leadership camp that offers leadership training, assertiveness training, deaf awareness, leisure and social activities, and athletic events. It also is involved in the Kuli Senior Citizens Club which provides community activities such as arts and crafts, field trips, social events, and workshops for elderly deaf citizens. The ASAD also sponsors an annual Deaf Awareness in Hawaii event in conjunction with National Deaf Awareness Week. Finally, it also helps to sponsor the Miss Deaf Hawaii Pageant for local deaf young women to compete for the national crown.

According to the ASAD, its objectives are to:

1. Advocate for the educational and civil rights of hearing-impaired citizens of Hawaii;

Develop a better image of hearing-impaired people;

3. Improve the quality and standard of living for all deaf and hard of hearing people;

Promote better public services for deaf and hard of hearing people such as:

• Deafness information and referral services;
• Legislative issues;
• Public relations;
• Representation of the deaf community in the State of Hawaii
• Tourism information for deaf visitors; and
• Workshops on special topics;

Sponsor the deaf youth leadership camp program.

Definitions

Vocational Rehabilitation: H.C.R. No. 157, HD1, is concerned with vocational rehabilitation services for deaf and hard of hearing persons. In Hawaii, "vocational rehabilitation" is defined as ". . .making an individual able, or increasing the individual's ability to engage in, and placement in, a remunerative occupation through providing the individual needed vocational rehabilitation services."⁽¹³⁾ Vocational rehabilitation is more broadly and liberally defined by the National Council on Rehabilitation.⁽¹⁴⁾ For the purpose of providing vocational rehabilitation services in the public sector, Hawaii law defines "handicapped individual" to encompass both hearing- and visually-impaired persons:⁽¹⁵⁾

Deaf and Hard of Hearing Persons: According to Stokes (1991), the term "deafness" is vague and a purely medical-audiological definition of deafness ("a hearing loss sufficient to interfere with the ability to hear speech") is unsatisfactory.⁽¹⁶⁾ Instead, Stokes defines deafness ". . . as a state in which the sense of hearing is nonfunctional for ordinary purposes of life."⁽¹⁷⁾ Hearing-impaired persons are commonly categorized as hard of hearing, severely deaf, and profoundly deaf.

About fifteen million people in the United States are hard of hearing. They suffer from a slight hearing loss but can usually manage to hear some speech with the help of hearing aids.⁽¹⁸⁾ This condition usually occurs after a person has already learned to speak and read a language as a hearing person. As a result, they continue to rely on speech (and sometimes, writing) -- and not sign language -- to communicate. Hard of hearing persons generally do not like being thought of as handicapped or "deaf." In their desire to remain in the mainstream, they tend to deny their disability and thus resist seeking help. Unfortunately, this compounds their frustration as their attempts to compensate almost invariably result in communication miscomprehension.

The severely deaf usually lose hearing early in life. Although they may have experienced hearing sounds and know the concept of speech, they may never have actually acquired speech or a language. The severely deaf are usually able to speak -- guided by the memory of sounds and speech -- but they often have great difficulty hearing. If they have not acquired a language, American Sign Language (ASL) or speech-reading are alternatives. The latter is notoriously inefficient. It has been estimated that the best speech-readers are able to "read" only 30% to 40% of words actually spoken.⁽¹⁹⁾ In addition, not all severely deaf may wish to learn ASL for the same reason that the hard of hearing disdain being labeled "deaf."

The profoundly deaf are born deaf. They have never acquired speech and thus have no common language with which to communicate with the hearing. Consequently, they usually use ASL, interpreters, or speech-read. Again, speech-reading is a poor alternative, especially for the profoundly deaf, because they need to "read" a spoken language they either have never learned or learned only as a second language. About two million Americans are profoundly deaf.⁽²⁰⁾ Whereas the severely deaf may have acquired enough of a spoken or written language to communicate by writing and reading notes, most profoundly deaf cannot. Without having learned a language like English, neither can they benefit from closed captioning in theaters or on television. Neither the profoundly deaf nor the severely deaf have any use for assistive listening devices that the hard of hearing, with their residual hearing, can make good use of.

Significance of Varying Degrees of Severity of Deafness

The realization that the deaf population does not comprise one monolithic or homogeneous population is important for at least two reasons. First, the different degrees of severity of deafness serve to differentiate the deaf population into subpopulations with distinctly different service needs. For example, the profoundly deaf have no use for hearing aids. The hard of hearing resist learning ASL and using interpreters. Secondly, differences also serve to create separate identities and cultures within each subgroup, especially among the profoundly deaf. As a result, there is no one uniform way to treat or assist "the deaf" and their self-perceived separate cultural identities complicate efforts to provide them the appropriate assistance. According to Stokes:⁽²¹⁾

"The ability to communicate in ASL is the criteria by which one is considered to be a member of the deaf community. Inclusion in the deaf community requires identification both with the language and the culture. Surprisingly, this identification is not shared by all individuals who are audiologically defined as deaf. Also, a few hearing people may be considered 'culturally deaf' if they acquire a certain mastery of ASL. . . Although the use of ASL provides a means of communication and a sense a community for those who know the language, it isolates the deaf from a general population that is ignorant of that language."

Services for the deaf and hard of hearing, therefore, must be appropriate for each subgroup and meet each subgroup's distinctly different needs. In addition, each subgroup's sensitivities -- reflecting their differing degrees of deafness -- need to be understood and taken into account in any treatment setting. However, it is not within the scope of this study to delve into the debate over various treatment modalities or the appropriateness of various alternatives for communication (e.g. "total communication" as opposed to ASL, Sign English, oralism, speech-reading, and hearing aids and other assistive listening devices, etc). The popularity or appropriateness of various approaches may fluctuate over time. What is important and what remains constant is that all those who provide services to the deaf and hard of hearing recognize and adapt to differing needs and sensibilities among the different subgroups of the deaf population.

Purpose of This Study and Methodology

As noted above, H.C.R. No. 157, HD1, re-directed the central task of examining how to provide more streamlined and comprehensive services to the deaf and hard of hearing, including the feasibility of creating a separate branch, from the Bureau to the DHS. No doubt, in its comprehensive investigation of various alternatives, the DHS will examine issues similar to those reviewed in this study. Therefore, the seven items to be examined by the Bureau constitute only a small subset of topics relevant to the central task of improving delivery of services to the deaf and hard of hearing in Hawaii. The purpose of this study, then, is to address the specific issues raised in H.C.R. No. 157, HD1 -- and possibly generate supporting data for the DHS in its efforts at restructuring.

The Bureau requested the six organizations to be consulted to respond to a survey prepared by the Bureau covering the seven issues. Where necessary or appropriate, the surveys were supplemented with pre- or post-survey interviews, or both. All groups were asked to respond to questions that address all the issues named in the resolution with two exceptions. Only the DVR was asked to respond to issues regarding client/staff ratios and the number of high school students referred for DVR services because the other groups have no relevant data to offer. In addition, the Hawaii Center for the Deaf and the Blind (HCDB) was asked for information on the number of student referrals for DVR services.

In general, the surveys requested the six groups to respond to five (seven for the DVR) groups of questions corresponding to, although not in the order of, the seven issues listed in the resolution.⁽²²⁾

Issue One: Client/Staff Ratios: Only the DVR was asked to provide data on client/staff ratios. In order to establish ratios, the DVR was first requested to provide data for direct services (not administrative or clerical) provided to both blind and deaf or hard of hearing clients; to blind clients only; and to deaf or hard of hearing clients only. Next they were asked for data on staffing and clients served. The number of clients at issue is the smaller number who actually received services, and not the larger number of total referrals or the number that applied for eligibility determination. To adhere closer to the resolution's intent, the DVR agreed not to include those clients who were both deaf and blind for the purposes of the survey.

The Bureau asked for a listing of actual full-time equivalent (FTE) positions devoted to providing direct vocational rehabilitation services, excluding unfilled positions. Data were broken down into actual FTEs for all direct services; services for the blind; and services for the deaf or hard of hearing. Data were also obtained on the number of blind and deaf or hard of hearing clients who actually received vocational rehabilitation services in each of the last three fiscal years.⁽²³⁾ As a check, data on the number of DVR staff providers were obtained in a separate section. In eliciting FTE data, the Bureau provided the DVR with certain guidelines.⁽²⁴⁾

[See this footnote for specific survey instructions and guidelines.]

[The resolution mentions several specific services.⁽²⁵⁾

(See this footnote discussing "vocational rehabilitation services" in general and other services specifically cited in the Hawaii Revised Statutes and in the resolution.) These include: "transition program" (issue 3), "support services on the job" (issue 3), "staff support" for clients placed in jobs (issue 5), and "adjustment services . . . due to the lack of coping skills to deal with problems that arise" (issue 7). The DVR reports providing transition services although they are not among those statutorily defined. Neither do they appear in the Hawaii Administrative Rules. However, the DVR does report it as one of the services its provides. Similarly, staff support does not appear in either the statutes or in the rules. Lastly, adjustment training is listed in both the statutes and the rules. However, what it means appears to be nebulous and flexible.]

Issue Two: Number of Deaf and Hard of Hearing High School Students to be Referred for DVR Services: Again, only the DVR and the HCDB were asked to respond to a group of five questions regarding the number of deaf and hard of hearing high school students aged 16 and older who were referred to the DVR for servicese in the past three fiscal or calendar years.

Issue Three: Gaps in Services for Deaf and Hard of Hearing Students: All groups were asked to identify gaps in services for deaf and hard of hearing students and ways to fill those gaps. Each group was also asked to comment on language in the resolution citing ". . . such as having a transition program/counselor at the Hawaii Center for the Deaf and the Blind, underemployment, and support services on the job."

Issue Four: Need for Qualified Providers Who Are Deaf or Hard of Hearing: The DVR was the first group to be surveyed on this issue. A total of 31 questions were asked (subsequently compressed into 18 for the other groups) to elicit attitudes and opinions regarding this issue. The questions generally revolved around the need for, and benefit, effectiveness, or value of, employing service providers who possess certain traits identified in the resolution. These were being:

1. Knowledgeable specifically about the implications of hearing loss;

Fluent in American Sign Language; and

3. Sensitive to the specialized needs of deaf and hard of hearing persons.

The survey attempted to assess attitudes and opinions regarding whether deaf or hard of hearing providers are essential, are more likely to possess the three traits, above, or provide better services (as opposed to equally qualified hearing providers). Preferences of the deaf and hard of hearing regarding providers who themselves are deaf or hard of hearing and hearing providers were also solicited. The Bureau also tried to determine how many qualified deaf or hard of hearing staff there were in the DVR and how all respondents felt about the viability of training existing hearing providers as an option.

Issue Five: Need for Staff Support for Clients Placed in Jobs: The survey attempted to determine from the DVR what support services are, whether they are generic or different for each population, and what proportion of clients placed in jobs received this service. All groups were asked if they felt staff support services were needed, what obstacles prevent the provision of more staff support, and what steps could be taken to overcome those obstacles.

Issue Six: Impact of Change in Service Delivery from the HSOD to Goodwill: Background information on the change was sought. In addition, the opinions of all six groups were solicited on how each group viewed the impact of the change on deaf and hard of hearing clients.

Issue Seven: Need for Adjustment Services for Deaf and Hard of Hearing Persons: Again, the survey attempted to determine from the DVR what adjustment services are and whether they are generic or different for blind and deaf or hard of hearing clients. All groups were asked if they felt adjustment services were needed, what obstacles prevent the provision of more adjustment services, and what can be done to eliminate those obstacles.

25. "Vocational rehabilitation services" in the public sector is defined in 348-2(4), Hawaii Revised Statutes, as:

"(A) Diagnostic and related services (including transportation) incidental to the determination of whether an individual is a handicapped individual, and if so, the individual's eligibility for, and the nature and scope of other vocational rehabilitation services to be provided; and(B) The following services provided eligible handicapped individuals needing the services: (I) Training; (ii) Guidance; (iii) Placement; (iv) Maintenance, not exceeding the estimated costs of subsistence during vocational rehabilitation; (v) Occupational licenses, tools, equipment, initial stocks, and supplies (including equipment and initial stocks and supplies for vending stands), books, and training materials; (vi) Transportation (other than provided as diagnostic and related services); (vii) Physical restoration; (viii) Reader services for the blind; (ix) Interpreter services for the deaf; (x) Telecommunications, sensory, or other technological aids and devices; (xi) Services to family members; (xii) Post employment services; (xiii) Other goods and services which will benefit an individual's employability."

"Maintenance," as defined in 348-2(4)(B)(iv) and 348-2(7), HRS, means:

". . . payments, not exceeding the cost of subsistence, provided an eligible handicapped individual necessary to derive the benefit of other vocational rehabilitation services being provided to achieve the individual's vocational rehabilitation objective."

According to 348-2(4)(B)(vii) and 348-2(5), HRS, "physical restoration" includes:

"(A) Corrective surgery or therapeutic treatment necessary to correct or substantially modify a physical or mental condition which is stable or slowly progressive and constitutes a substantial handicap to employment, but is of such a nature that the correction or modification may reasonably be expected to eliminate or substantially reduce the handicap within a reasonable length of time; and includes psychiatric treatment, dentistry, physical therapy, occupational therapy, speech or hearing therapy, treatment of medical complications, and emergencies which are associated with or arise out of physical restoration services or are inherent in the condition under treatment, and other medical services related to rehabilitation;(B) Necessary hospitalization (either in-patient or out-patient) and nursing care in connection with surgery or treatment specified in the preceding subparagraph (A);(C) Prosthetic devices essential to obtaining or retaining employment."

Additional services not included in 348-2(4), HRS, but encompassed in language defining a "rehabilitation facility" as contained in 348-2(10), HRS, are as follows:

"(10) The term "rehabilitation facility" means a facility operated for the primary purpose of assisting in the rehabilitation of handicapped individuals: (A) Which provides one or more of the following types of services: (I) Testing, fitting, or training in the use of prosthetic devices; (ii) Prevocational or conditioning therapy; (iii) Physical or occupational therapy; (iv) Adjustment training; (v) Evaluation or control of special disabilities; or (B) Through which is provided an integrated program of medical, psychological, social, and vocational evaluation and services under competent professional supervision."

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