This chapter deals with two related issues -- issues five and seven of the resolution:

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

(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."

Issue seven is taken out of turn because it is related to issue five. Issue six -- the impact of the change in service delivery from the Hawaii Services on Deafness (HSOD) to Goodwill -- is a wholly separate issue and is dealt with in the next chapter. Unless otherwise indicated, quoted material is attributed to the respective respondent group.

Issue Five: Need for Staff Support for Clients Placed in Jobs

A 1994 U. S. Department of Education publication⁽¹⁾ on the topic of deaf and hard of hearing students in postsecondary education helps to shed light on the nature of support services. The study surveyed, among other things, the types of support services provided by two- and four-year postsecondary educational institutions in the fifty states and Washington, D.C. and Puerto Rico. Data were collected for the four academic years from 1989-1990 through 1992-1993. Support services, in summary form, that were offered consisted of:⁽²⁾

"1. Sign language interpreters or transliterators (use manual communication for voice-to-sign and sign-to-voice interpretation);

Oral interpreters or transliterators (facilitate speech reading by silently repeating what is said, with facial and gestural enhancements and selective semantic rewording);

3. Classroom notetakers (take notes during class sessions to enable deaf and hard of hearing students to focus attention on the instructor or interpreter);

Tutors to assist with ongoing coursework (teach coursework in subject area; tutors know how to communicate with deaf and hard of hearing and also know the subject area);

5. Assistive listening devices (systems for classrooms that augment and clarify sound, such as personal and group FM systems, loop systems, and infrared systems); and

Other support services (special testing accommodations, personal, academic, vocational, or career counseling, assistance with registration, classroom seating arrangements, tape recording, and advocacy or consultation with instructors)."

Vocational Rehabilitation and Services for the Blind Division (DVR) Response: The DVR reports that staff support services consist of the "arrange[ment, by staff,] for sign language interpreter services or assistive listening devices." Consequently, staff support probably refers to the statutorily-defined "interpreter services for the deaf" (348-2(4)(B)(ix), HRS) and "telecommunications, sensory, or other technological aids and devices" (348-2(4)(B)(x), HRS), or both. Both of these services are also provided for in the Hawaii Administrative Rules (HAR). According to 17-401-16(a), HAR (Department of Human Services) regarding "Interpreter services for the deaf," the DVR is required to:

". . . provide manual interpreting services for deaf applicants and clients when necessary to assure the provision of efficient and meaningful VR services to the deaf . . . [and to] provide interpreter services for the deaf, as appropriate, throughout the VR process."

According to 17-401-16(c)(1), HAR, interpreter services are to be provided without the need for applying an economic means test when they are:

". . . in support of the following:(A) VR services of a diagnostic nature;(B) Counseling, guidance, and referral services; and(C) Placement services."

According to 17-401-18(a), HAR:

". . . telecommunications, sensory and other technological aids and devices shall be provided, as appropriate, to help VR clients achieve their vocational rehabilitation goals.(1) Technological devices and services may be provided during an extended evaluation to determine eligibility for rehabilitation services, during the period of rehabilitation to eligible clients, and during vocational training or on-the-job training as equipment needed to perform the selected occupation."

According to the DVR, support services are not generic for all disability populations. Deaf persons do not need braille embossing equipment meant for the blind nor hearing aids meant for the hard of hearing. Similarly, the hard of hearing mostly have little use for American Sign Language interpreters and a suggestion to learn it is considered insulting. According to the DVR, various types of staff support services are needed for hearing-impaired clients placed in jobs because of difficulty communicating with hearing employers and co-workers. Clients often need counselor assistance to help them understand their role as employees. Because of poor education and deficient experience in socialization, the deaf find it hard to adopt work habits commonly taken for granted such as punctuality and carrying out an assigned task through to completion.

The DVR feels that the limited time that the current staff has available to devote to staff support is an obstacle to providing more support. Its suggested solution is to hire more staff, which requires increased funding. There are only a limited number of DVR staff serving the deaf and hard of hearing population (one full-time vocational rehabilitation counselor and one full-time and one half-time social service assistants).

Hawaii State Coordinating Council on Deafness Response: Not unexpectedly, the HSCCD believes that staff support services are needed. One caveat, though, is that "Special communication and language needs are involved and require individualized services." The HSCCD cites ". . . poor, or lack of, independent living skills and work habits [that] often interfere with the client's ability to hold down jobs." Lack of professional and communication training for staff is viewed as an obstacle to providing more staff support services. Funds that may support this needed training are lacking at the same time that the state budget has been cut. In addition, the HSCCD warns that the problem is especially critical for those on the neighbor islands and in rural areas of Oahu.

Similar to its recommendation regarding the provision of more adjustment services (below), the HSCCD counsels the centralization of services for deaf and hard of hearing clients. According to the HSCCD, this would minimize lag times in the service process, utilize current staff more efficiently, and enable more staff to be recruited to meet caseload demands. Moreover, the HSCCD advocates the establishment of an interpreter position in the DVR to help DVR staff not proficient in sign language to serve both Oahu and the neighbor islands. Further recommendations include the hiring of job coaches and tutors and the contracting out for follow-up services.

Hawaii Services on Deafness Response: The HSOD pointed out that funding is a major consideration in providing support services such as interpreters. There is a need for psychologists who sign and for interpreters in general.⁽³⁾ It also commented that:

"With increased community education and awareness, greater numbers of employers may be made aware of the wide range of skills and work potential of the deaf and hard-of-hearing, the ADA [Americans with Disabilities Act], and their responsibilities to provide equal communications access to the deaf and hard-of-hearing in work situations."

Goodwill Industries of Honolulu, Inc. Response: Not surprisingly, Goodwill agrees that there is a need for staff support. However, Goodwill points out a need to differentiate between deaf or hard of hearing individuals who have other physical or psychological limitations due to additional disabilities and those who do not. The former require ". . . more intensive support based on the specific limitations faced and strategies employed to address those limitations." The latter ". . . do not need as much support . . . [and] may require supports such as the need for an ASL interpreter in order to participate in discussions with their employers, or for certain supports outside of the work environment."

The major obstacle, according to Goodwill, to providing more staff support is the same as that obstructing the provision of other vocational rehabilitation services for the deaf and hard of hearing:

"Again, we identify the biggest barrier as being lack of qualified ASL interpreters who also have employment and placement experience and capabilities. There is a lack of an educational system that is capable of training enough ASL interpreters as well as a lack of resources to hire additional staff when they are available."

Ohana Kokua Ano Kuli Response: The OKAK feels that there is a need for staff support services. Its reason for taking this position is the same as that for believing that there is a need for adjustment services. It reasons that obtaining "any simple job" is not too hard. However, it contends that ". . . maintaining successful employment is much more difficult. Adjustment services [and] staff support would help provide for more successful and long-term employment of deaf and hard of hearing people." The OKAK believes an obstacle to the provision of more support and adjustment services is the lack of service providers and counselors who are sensitive, understanding, and knowledgeable of the needs of deaf and hard of hearing people. Accordingly, it advocates the use of these personnel.

Aloha State Association of the Deaf Response: The ASAD agrees that there is a need for staff support services. It believes that DVR clients will be helped to become more motivated and to gain self-esteem. According to the ASAD, a "job club" program has been reinstated within the DVR after a lapse of about two or three years. The ASAD related an account of one of its volunteers who had attended that club and who reported having enjoyed the experience. That person now feels prepared to visit the state employment office and finds that looking up potential job openings in the office's computer is "neat."⁽⁴⁾

Issue Seven: Need for Adjustment Services for Deaf and Hard of Hearing Persons Due to the Lack of Coping Skills to Deal with Problems that Arise

It is not entirely clear what "adjustment services" means. The term "adjustment" makes various appearances throughout the statutes and rules. For example, "vocational adjustment" is described as being included under "vocational and other training services" in 17-401-4(a)(1)(D), HAR. Under training services (17-401-12(b)(3), HAR), "personal adjustment training" is described as including training given for any one or a combination of the following reasons:

"(A) To assist the individual to acquire personal habits, attitudes, and skills that will enable the individual to function effectively in spite of the individual's disability;(B) To develop or increase work tolerance before engaging in prevocational or vocational training or in employment;(C) To develop work habits and to orient the individual to the work world; and(D) To provide skills or techniques for the specific purpose of enabling the individual to compensate for the loss of a member of the body or the loss of a sensory function."

Adjustment also takes place as part of follow-up services after job placement to assure the success and performance of the placement. According to 17-401-23(d), HAR, follow-up services deal with:

"(1) Client's job performance;(2) Adjustment to the job, supervisor, and co-workers;(3) Safety and health factors;(4) Needed interventions for emerging problems;(5) Assisting employers in understanding and accommodating the disabled individual; and(6) Assuring the stability and permanence of the job placement."

According to 17-401-4(a)(1)(B), HAR, "personal adjustment counseling" is part of "counseling and guidance" where a ". . . counseling relationship [is maintained] throughout a handicapped individual's program of services." It is further described in 17-401-10(a)(6), HAR: "Adjustment in a suitable job to the satisfaction of all parties concerned."⁽⁵⁾

DVR Response: The DVR listed adjustment under "counseling and guidance" services for both the blind and the deaf or hard of hearing. Counseling and guidance includes "understanding and relating health, disability, personal, and social problems to clients' vocational adjustment." Furthermore, the DVR reported adjustment under "work evaluation and work adjustment training." However, this latter was listed under services for blind clients only; its component services are defined in 17-402-16(a)(2), HAR:

"(2) Adjustment-training services shall include an extended period of prevocational exploration and development, specified vocational adjustment and training, training for sheltered workshop employment, and documentation of such services."

The DVR also commented⁽⁶⁾ that adjustment services are oriented more towards dealing with conditions external to the person. For example, a client may need help in adjusting to problems generated by having a job and dealing with co-workers and supervisors on both work and personal levels, and dealing with pressures and relationships arising at home. On the other hand, counseling is more internally oriented, having to do more with addressing a client's psychological needs. In a complementary remark in response to the Bureau's survey, the DVR comments that "adjustment services" are needed to cope with:

"Problems with federal and state assistance programs, housing, employment and adjustment to employment. Because of communication, difficulties both in person and in writing, deaf and hard of hearing clients often need assistance."

The DVR affirmed that adjustment services are a necessary part of its program of services. Adjustment services are provided to almost all deaf or hard of hearing clients, except for a very small percentage who do not need it.⁽⁷⁾ These services are not generic for the blind and deaf or hard of hearing groups because adjustment depends on and varies with the nature of one's disability. Even within the deaf or hard of hearing subgroup, differing degrees of hearing-impairment (deaf vs. hard of hearing) may require different adjustment services. In general, the coping skills that clients lack and that make adjustment services necessary include the ability to understand social and work situations in the way that non-impaired persons perceive them. These include appropriate work attitudes and habits and understanding employers' expectations regarding work. They also include the ability to deal with the frustrations that inevitably arise from a disabled person's limited functioning in work and social settings. Ideally, adjustment services help to improve disabled persons' reaction to and handling of work and social situations. The DVR also identified as an obstacle to providing more such services the fact that "existing staff do not have the time to provide the services needed." As a solution, the DVR suggested "hiring more staff to provide adjustment services."

Hawaii State Coordinating Council on Deafness Response: The HSCCD agrees that there is a need for adjustment services for deaf or hard of hearing clients placed in jobs which is:

". . . individual, based on each employment situation and on each client's ability to do the essential functions of the job. Special adaptive modification and assessment may be needed, but adjustment services also involves more than just helping with job adjustment. Many clients need to learn not only work skills and work ethics, but also independent living skills (living on own, transportation, money management, functional reading/writing skills, interpersonal relationships, etc.)"

The HSCCD's inclusion and definition of independent living skills as part of adjustment services appears to contrast with how "adjustment services" is treated in the statutes, the rules, and by the DVR. (The DVR reported assistance with activities of daily living under "personal assistance services" and reported "transportation services" separately. Furthermore, the DVR provides "personal and home management services" (albeit for blind clients only) which includes activities of daily living such as grooming and eating and instrumental activities of daily living such as shopping and cooking. [See chapter 2.])

Like the DVR, the HSCCD sees the lack of adequately trained staff and service programs as obstacles to providing more adjustment services. The HSCCD offers two solutions: "Centralize coordination of adjustment services to tie in with vocational services. Contract out with more agencies with trained staff for adjustment services."

Hawaii Services on Deafness Response: The HSOD's view on the need for adjustment services for clients placed in jobs is that "it depends on the job and the circumstances of hiring." The HSOD would prefer that deaf or hard of hearing clients prepare for job opportunities in the same way that hearing people do, that is, with prior education and training for selected careers. It hopes that, through increased efforts at community education, more employers will become aware of the wide range of skills and the work potential of deaf and hard of hearing individuals, and of employers' responsibility to provide equal communications access for the deaf and hard of hearing in work situations as mandated by the American with Disabilities Act. The HSOD also indicated that a lack of funding for adjustment programs is a major obstacle.⁽⁸⁾

Goodwill Industries of Honolulu, Inc. Response: The deaf and hard of hearing population constitutes only about five percent of the larger population served by Goodwill. Goodwill provides, under contract, adjustment services to DVR clients. Goodwill believes that there is a need for adjustment services. However, it feels that they are best introduced after a job has been obtained. According to Goodwill, adjustment services are currently provided to clients before progressing to the training and job search and placement functions. Goodwill feels that the skills that are learned are often lost by the time a job is obtained because, in the interim, clients have no chance to practice the skills they have learned in real work situations. Adjustment services as they are now provided -- before obtaining a job -- have value and should be continued, according to Goodwill. However, the benefits of such services cannot be maximized. Providing adjustment services after getting a job allows the service to be ". . . tailored to real life situations where the need to reach competency has practical meaning."

Goodwill's view of obstacles to providing more adjustment services reflects an oft-cited view:

"A primary obstacle [to] providing additional services is the lack of qualified personnel who are knowledgeable in both ASL and experienced in overall case management and counseling as a profession. In addition, there is a lack of revenue and resources required to plan for the best service delivery system . . . The most desirable program design would be to have Deaf service providers working with the Deaf population. It is also true, however, that there is a goal . . . for increased integration of persons who are Deaf and hard of hearing into the hearing community. A service delivery system that [allows for both] Deaf service providers as well as hearing service providers will be needed as long as such a [lack] of Deaf service providers exist[s]."

Ohana Kokua Ano Kuli Response: The OKAK response to this issue was the same as for issue five, above, regarding the need for staff support for clients placed in jobs. [See issue five above.]

Aloha State Association of the Deaf Response: The ASAD agreed that there is a need for adjustment services for deaf or hard of hearing clients placed in jobs. However, the ASAD apparently took the issue to apply only to students. Nonetheless, its views are presented below:

"Yes, [adjustment services are needed] because some . . . students who immigrate to Hawaii or are mainstreamed [in the school system] are not knowledgeable about independent living skills. That kind [of assistance] should be a part of the school program so the juniors and seniors will be better prepared for the [reality of being] 'out-in-the-world.' There is also no program at [the] HCDB [at] this time. There are problems with the students from neighbor islands who are enrolling at Kapiolani Community College (KCC) as they have no skills in being independent to manage their [Supplemental S]ecurity Income benefit checks . . . a group home or an apartment for independent living skills training would be great for them."

1. U.S., Department of Education, Deaf and Hard of Hearing Students in Postsecondary Education: Statistical Analysis Report, Office of Educational Research and Improvement, National Center for Education Statistics, NCES 94-394, March, 1994.

2. Ibid., pp. 18-19.

3. HSOD response received October 7, 1996.

4. It appears, however, that the ASAD's response to the need for staff support may inadvertently have been addressing somewhat different services, such as adjustment services or other vocational rehabilitation services not precisely having to do with language interpreter services or assistive communications services. The ASAD seems to be addressing job preparation and job searching activities.

5. The term "adjustment training" also appears in 348-2(10)(A)(iv), HRS, as one of five types of services provided by a rehabilitation facility. (The others are (1) testing, fitting, or training in the use of prosthetic devices; (2) prevocational or conditional therapy; (3) physical or occupational therapy; and (4) evaluation or control of special disabilities.)

6. DVR interview of July 2, 1996 with Neil Shim, administrator, Vocational Rehabilitation Services for the Blind Division, and Carol Young, program coordinator, DVR..

7. DVR interview of July 2, 1996. The DVR reports that about 98% of all clients placed in jobs receive adjustment services.

8. HSOD response received October 7, 1996.

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