This chapter is divided into two sections. The first contains a summary of findings and the second, conclusions regarding the seven issues the Bureau has been requested to examine.

Summary

1. The Vocational Rehabilitation and Services to the Blind Division (DVR) within the Department of Human Services provides vocational rehabilitation services to multiple populations of the disabled. The blind and the deaf are relatively large subgroups of the disabled served by the DVR. The DVR has a Services to the Blind Branch. It does not have a separate branch for the deaf.

2. The DVR served slightly more blind clients than deaf or hard of hearing clients over the last three fiscal years. A yearly average of 265 blind vs. 222 deaf or hard of hearing clients were served from FY 1994 through FY 1996. Over the same period, 14.5 full-time equivalent (FTE) positions within the DVR provided direct vocational rehabilitation services to the blind while 2.5 FTE positions provided services to the deaf or hard of hearing. In terms of client/staff ratios, these were: 16.8-to-1, 19.8-to-1, and 18.3-to-1 for the blind, and 77.6-to-1, 92.8-to-1, and 92.5-to-1 for the deaf or hard of hearing for the last three fiscal years.

3. The DVR provides seventeen direct services to both the blind and the deaf or hard of hearing. In addition to these, the DVR provides fourteen other direct services exclusively to blind clients and one other direct service exclusively to deaf or hard of hearing clients.

4. The number of deaf or hard or hearing high school students aged sixteen or older who were referred to the DVR for vocational rehabilitation services in the last three school years varied from four to nine per year. The DVR expects a slight increase in referrals over the next 1-, 3-, 5-, and 10-year periods at from six to ten students per year. The Hawaii Center for the Deaf and the Blind (HCDB) expects an increase in referrals in the next 1-year period only and anticipates a leveling off and a stable number of referrals thereafter.

5. All groups consulted by the Bureau unanimously agreed that a gap in services to these students lies in the lack of a transition program/counselor or coordinator at the HCDB. The following were also cited as further gaps in services to these students:

• A lack of more extensive career and higher educational counseling similar to that provided for hearing students; and community education efforts to raise awareness of these greater opportunities;
• A lack of exposure to adaptive equipment, assistive technology, and reasonable accommodations for the deaf and hard of hearing to help smooth the transition to the workforce; and
• A lack of successful deaf or hard of hearing adult role models.

The following were suggested as ways to fill the identified gaps in services:

• Establishing at the HCDB a coordinated plan for all deaf or hard of hearing students regarding transition to the work world;
• Increasing the number of trained staff;

• Providing more extensive staff development;
• Improving coordination among responsible state agencies;
• Revising the order of selection of students for services to enable them to receive services before graduation;
• Increasing awareness of career and higher educational opportunities through statewide workshops for deaf and hard of hearing students;
• Instituting at an early stage a referral service to private providers to address the issue of transition to the work world;
• Improving overall coordination of vocational rehabilitation services to students;
• Gathering statistics on unemployment and underemployment of deaf or hard of graduates to support the need for a transition program or counselor at the HCDB;
• Increasing staffing at the HCDB to four full-time positions for these students; and
• Establishing a separate branch within DVR for deaf or hard of hearing persons.

6. With respect to the need for qualified deaf or hard of hearing vocational rehabilitation service providers, all groups consulted⁽¹⁾ strongly agreed that:

• There is a need for qualified vocational rehabilitation personnel who are deaf or hard of hearing;
• Hearing impairment creates communication difficulties requiring the services of professionals who possess three traits: being knowledgeable specifically about the implications of hearing loss; being fluent in American Sign Language (ASL); and being sensitive to the specialized needs of the deaf or hard of hearing; and
• Services to deaf or hard of hearing persons are less effective if providers do not possess these three traits.

7. All but one group generally disagreed that only deaf or hard of hearing providers (as opposed to equally qualified hearing providers) can be knowledgeable, ASL-fluent, and sensitive. Table 7-1 below depicts responses to the statement that ONLY deaf or hard of hearing providers can be knowledgeable, fluent in ASL, and sensitive to the needs of deaf or hard of hearing clients.

D+ = disagree strongly; D = disagree somewhat; (~) = no opinion; A+ = agree strongly; A = agree somewhat

Note: Two separate surveys were received from the HSOD on 9/30/96 and 10/7/96; thus the dual responses.

8. Similarly, all but one group generally disagreed that qualified hearing providers, on balance, cannot be as knowledgeable, compared to qualified deaf or hard of hearing providers. Opinions were less uniform for the ASL-fluency and sensitivity traits. Table 7-2 depicts responses to the statement that qualified hearing providers, on balance, CANNOT be as knowledgeable, fluent in ASL, or sensitive, as compared to qualified deaf or hard of hearing providers.

9. Most groups consulted disagreed that there was no difference in the qualify of services provided by deaf or hard of hearing providers and hearing providers, assuming that the two are otherwise equally qualified. (That is, most felt there was a difference.)

However, there was sharp disagreement over whether deaf or hard of hearing clients benefit more from deaf or hard of hearing providers as compared to otherwise equally qualified hearing providers. (Three groups felt clients benefitted more; two groups felt they did not.)

10. Most groups felt that deaf or hard of hearing providers give better services than hearing providers by virtue of their being disabled, assuming the two groups are otherwise equally qualified.

11. There was general agreement (although in varying degree) that deaf or hard of hearing clients identify more with and are more receptive to services given by qualified providers who themselves are deaf or hard of hearing, as compared to hearing providers.

12. However, there was no general consensus that the use of qualified deaf or hard of hearing providers over qualified hearing providers is essential, and not just preferable.

13. There was a general feeling that current hearing providers can be trained to provide services as well as equally qualified deaf or hard of hearing providers, assuming that the latter provide better services, and that such training is an option.

(~) = no opinion

	DVR	HSCCD	HSOD	Goodwill	OKAK	ASAD
Hearing providers can be trained to provide services as well as equally qualified deaf or hard of hearing providers; such training is an option	D	A	(~)/A	A+	A+	NA

14. All groups surveyed believed that there is a need for staff support for clients placed in jobs. Obstacles to the provision of more staff support were identified as follows:

• Limited time of current staff to devote to staff support; lack of staff;
• Lack of professional and communication training for staff;
• Lack of funds for staff training;
• Continuing general state budget cuts;
• Lack of qualified American Sign Language interpreters who also have employment and placement experience and capabilities;
• Inadequate educational system that is incapable of training enough ASL interpreters; and
• Lack of funds to hire qualified staff.

Recommendations by the groups surveyed to overcome these obstacles include:

• Increased funding to hire more staff;
• Centralization of services for deaf and hard of hearing clients to minimize lag times for all services including staff support; to utilize existing staff more efficiently; and to enable more staff to be recruited;
• Establishment of an interpreter position in the DVR to help DVR staff not proficient in ASL to serve both Oahu and neighbor island clients;
• Hiring of job coaches and tutors; and
• Contracting out for follow-up services.

15. Like staff support, all groups surveyed agreed there is a need for individualized adjustment services that help improve disabled persons' reaction to and handling of work and social situations. Obstacles preventing the provision of more adjustment services were identified as:

• Limited time of current staff to devote to adjustment services; lack of staff;
• Lack of qualified staff who are knowledgeable in both ASL and who are experienced in overall case management and counseling as a profession; and
• Lack of revenues and resources.

Recommendations by the groups surveyed to overcome these obstacles include:

• Hiring additional staff to provide adjustment services;
• Centralizing coordination of adjustment services to tie in with vocational services;
• Contracting out with more agencies with trained staff for adjustment services;
• Increasing community education to raise employers' level of awareness of their responsibilities and the needs and skills of deaf and hard of hearing employees;
• Providing adjustment services after, rather than before, getting a job to maximize effectiveness of the service; and
• Working toward a system that allows both hearing and deaf or hard of hearing providers to provide services including adjustment services.

16. Goodwill Industries of Honolulu, Inc. began providing adjustment services under contract with the DVR in January 1996, taking over from the Hawaii Services on Deafness. The perceived impact on deaf or hard of hearing persons of the change in service delivery reported by the groups surveyed was a possible reduction in the number of clients seeking services because of:

• General unfamiliarity with the new service provider and staff on the part of clients who have a disability the nature of which requires trust that takes time to build;
• Clients' aversion to being associated with the new provider because of its other programs that serve persons with other disabilities, particularly mental retardation;
• The new provider's relatively awkward geographic location;
• Lack of staff who can communicate effectively in American Sign Language with clients;
• Clients' unmet expectations of being assisted with miscellaneous tasks not contracted for but which the previous provider had habitually performed; and
• Clients' disappointment at not obtaining jobs stemming from the misperception that the contracted service is primarily job placement and not adjustment services to help prepare clients to get and keep jobs (referrals of clients who reportedly have a primary need of employment with only secondary underlying disability issues that need to be dealt with through adjustment services).

Conclusions

The seven specific issues the Bureau has been directed to examine form neither a unified nor comprehensive basis for evaluating any one overall solution or approach to providing vocational rehabilitation services to the deaf and hard of hearing. Therefore, the study's conclusions are limited to the seven issues at hand. The inclusion of these issues in the resolution appears to reflect the view among some consumers and advocacy groups within the deaf and hard of hearing community that certain specific problems should be explored. These issues touch on disparate aspects of services to the deaf or hard of hearing. They do not work in concert toward any one goal, such as the feasibility of creating a separate deaf branch within the DVR. Rather, they address distinctly different service problems. Nonetheless, the information gathered in this study may be of use to the Department of Human Services in its consideration of internal divisional restructuring. Indeed some survey respondents felt that a streamlined, separate deaf branch providing coordinated and centralized services would go a long way towards resolving, or at least alleviating, some of the specific problems examined in this study.

Client/Staff Ratios: To begin with, the inclusion of the first issue relating to client/staff ratios in the resolution appears aimed at establishing that the deaf or hard of hearing subgroup, based on its numbers, merits equivalent treatment from the DVR vis-à-vis the blind subgroup. In fact, the numbers of blind and deaf or hard of hearing clients served by the DVR in recent years were in the same approximate range. However, the numbers of DVR staff devoted to providing services for the two subgroups diverged widely, with many more staff providing services to blind than to deaf clients. This is reflected in the rather lopsided client/staff ratios reported in chapter 2 and in the "Summary" section above. The blind subgroup also receives more services than the deaf subgroup. Based on these findings, there seems to be no question that the deaf are not receiving services from the DVR on a par with the blind subgroup.

At the same time, there is also no question that the Department of Human Services is required to provide vocational rehabilitation services to multiple populations, including the deaf or hard of hearing subgroup. That the blind and deaf populations have different needs should not obscure the fact that the deaf population has not been receiving services on a par with the blind population. Equal treatment does not necessarily mean providing both groups with identical services, precisely because their respective needs differ. Nonetheless, it is reasonable to conclude that, taking into account any differences in (or even degree of) need between the two groups, the number of services and staff devoted to vocational rehabilitation for the deaf group should be substantially greater than at present. The Department of Human Services and the DVR should immediately develop a detailed plan to rectify this imbalance that includes the recruitment of new staff and the training and development of existing staff to provide vocational rehabilitation services to the deaf and the hard of hearing.

Need for Qualified Deaf or Hard of Hearing Staff: An argument can be made that no staff are available to provide such services. However, several assumptions first need to be aired. First, is there an absolute and essential need for vocational rehabilitation staff who, themselves, are deaf? Second, is it essential to meet this need immediately? If the need for deaf professionals is essential and immutable, then the pool of potential recruits becomes drastically restricted. If not, then the reality of achieving parity of treatment vis-à-vis the blind population becomes much more attainable as a larger pool of talent becomes available. As all agree, there are few, if any, such qualified deaf or hard of hearing persons locally. Recruiting from the mainland remains an option, although possibly a costly one.

It is entirely understandable that using qualified deaf or hard of hearing professionals to provide vocational rehabilitation services to the deaf population is highly desirable. It is clear that the difficulty in communicating between hearing and deaf and hard of hearing persons is unique. It is also clear that staff who can use American Sign Language communicate more easily with their deaf clients. It has been almost universally asserted that staff who are fluent in ASL have an advantage over those who are not. In addition, it is only logical that the process of, and the motivation for, becoming fluent in ASL would render a person quite knowledgeable about the specific implications of hearing loss -- another trait identified as being essential for serving the deaf. Furthermore, it is difficult to conceive of any person who is both knowledgeable and fluent in ASL to be insensitive to the special needs of the deaf or hard of hearing.

The question is, does the description of staff above pertain to deaf or hard of hearing staff or to hearing staff? Can the description apply to both? Clearly, a deaf person may have an advantage over a hearing person in learning and communicating in ASL just as a native speaker of any language has an edge over someone learning that language as a second language. Similarly, a deaf person can more easily draw on personal experience for knowledge about the implications of hearing loss and in expressing a sensitivity to the special needs of the deaf while a hearing person cannot. Nonetheless, it is obvious that ASL fluency is not limited to deaf persons. However, knowledge of the implications of hearing loss can only be indirect and secondary for hearing persons. Yet, regardless of the source, knowledge can be attained. Likewise, sensitivity to the special needs of the deaf can be learned and be no less genuine and extensive for hearing persons. The bottom line is that hearing persons are at a disadvantage vis-à-vis deaf persons in attaining or expressing these three traits that have been identified as essential in providing services to the deaf or hard of hearing.

However, it should not mean that hearing staff are disqualified from providing services by virtue of not being deaf or hard of hearing. What is essential is that staff possess or acquire those three traits and use them, not whether a person is hearing or deaf. In other words, deaf or hard of hearing persons who are also professionally qualified to render vocational rehabilitation services to the deaf population are highly desirable but not absolutely essential to the exclusion of qualified hearing staff.

This said, it should also be clear that the pattern of staffing must be a two-way street. That is, just as qualified hearing staff can learn and should be trained in ASL and be educated to acquire other essential traits, deaf or hard of hearing individuals can and should be strongly encouraged and supported to obtain professional qualifications in the field of vocational rehabilitation.

The problem is, becoming fluent in ASL, learning about the implications of hearing loss (for hearing staff), and becoming professionally qualified (for deaf or hard of hearing persons) are goals that cannot be achieved quickly. This leads to the second assumption: Is it essential to meet the need for deaf or hard of hearing vocational rehabilitation staff immediately? Certainly, the dearth of qualified deaf or hard of hearing local or mainland recruits should not lock the system into using only qualified hearing providers. The immediate need is for services to be provided. Because qualified deaf staff are not available right now, available qualified hearing staff who may not know ASL must be used. However, a strong effort should be made immediately to upgrade existing staff skills, particularly in ASL fluency and specific knowledge of the implications of hearing loss. This upgrading process should not be seen as a short-term fix but should be continued over time. At the same time, a similar strong effort should be made to train deaf persons to become professionally qualified, or to recruit deaf persons already qualified.

In other words, the development of both qualified hearing and deaf or hard of hearing professional staff, especially in Hawaii, should be a long-term goal but one that should be embarked upon immediately. The training of existing hearing staff, the training of deaf persons to become professionally qualified, and the recruitment of already qualified deaf professionals should be begin immediately and should continue over the long-term.

Impact of Change in Service Delivery: The current lack of deaf or hard of hearing vocational rehabilitation staff, or at least staff who can sign, is a major reason why the change in service delivery from the HSOD to Goodwill is seen as an issue. Goodwill, the new provider, does not have a staffer who is fluent in ASL. After having been unsuccessful at locating and hiring a qualified deaf professional who can sign, Goodwill has begun ASL training for one of its staff. However, Goodwill's other programs, including those for persons with mental retardation, seem to be having a greater impact on deaf clients. That is, deaf clients are reluctant to be associated with Goodwill because of their desire to avoid being stigmatized as mentally retarded.

Furthermore, clients may feel uncomfortable with a new and unfamiliar situation. However, any change takes time for people to adapt to. This is particularly true for persons who have a disability the nature of which places a premium on confidence and trust -- things that take time to develop in any relationship. Perhaps in the case of deaf and hard of hearing persons, the change of provider may take longer to adapt to. In other words, current difficulties may simply require greater effort over time by both sides.

Dissatisfaction with the change to Goodwill also seems to stem from a fundamental misperception of what services are contracted out to Goodwill and what services clients appear to want. Goodwill is required to provide adjustment services by its DVR contract, not miscellaneous and incidental tasks that clients may have gotten used to receiving from the HSOD. Helpful though those extra tasks may have been to clients, they do not comprise adjustment services. Over time, as the service relationship between Goodwill and its clients matures, this new relationship may even spawn similar extra free "services" although any such eventuality would be impossible to predict.

Another example of this misperception lies in clients' expectation of receiving job placement rather than adjustment services from Goodwill. Clients seem more interested in getting placed right away whereas Goodwill expects to help deaf clients with accompanying disabilities to be better able to get and keep jobs by providing them with contracted adjustment services. The mismatched perceptions and expectations between provider and clients contribute much to dissatisfaction with services in general and with the change in services to Goodwill in particular.

Clients need time to get used to the new provider. Both sides need time to build trust. Aside from this, despite universal agreement that adjustment services are needed and in short supply, the DVR and other service and advocacy agencies may do well to reevaluate that need, especially in the context of what clients themselves seem to want. Perhaps "adjustment services" needs to be redefined to better reflect client needs. Or, perhaps, other services in addition to adjustment services need to be contracted out. As a result, the DVR may find that adjustment services could receive less emphasis, and job placement, more. The DVR may also wish to consider what type of clients it refers to Goodwill for services -- those that need adjustment services as they exist now or those who really just want to be placed in jobs. A shift in service priorities may involve contracting out to other providers for job placement, or expanding and improving in-house job placement services.

On the other hand, Goodwill may wish to consider moving its service location to a more

geographically accessible site. Although it has attempted to recruit a deaf professional who can sign and has invested in ASL training for one of its staff, Goodwill should redouble its efforts at either hiring a qualified professional who can sign or training current staff to be fluent in ASL.

Need for Adjustment Services and Staff Support: As already mentioned, adjustment

services need to be continued, preferably provided by professionals who can sign. The same applies to staff support, which all agree is scarce but needed. No conflict has arisen over staff support in the manner described above relating to adjustment services. But perhaps a similar dissatisfaction would have arisen if staff support (rather than adjustment services) were contracted out but where clients actually seem to want to be placed in jobs. In any case, there is no evidence that this would have occurred.

On the contrary, the lack of interpreters is a lasting problem that needs to be addressed through increased efforts at training and recruitment of staff and in education of the community in general and employers in particular about the rights and needs of the deaf and hard of hearing. In the matter of providing education, both the DVR and all service and community and advocacy groups need to share the burden.

To meet the need for adjustment services and staff support, the efficiency of current service delivery must be improved, services and staffing must be increased, or both. If new positions are needed, the legislature must have the will to fund them while the executive branch must commit itself to aggressively recruit new staff and train and develop existing staff. Like all other staffing difficulties examined in this study involving qualified vocational rehabilitation professionals, qualified interpreters need to be found or trained. This is a task for immediate action and should continue over the long-term until the need for staff support is adequately met.

Gaps in Services to Deaf and Hard of Hearing High School Students: Similar to the universal consensus on the need for staff support and adjustment services, all appear to agree that a major service gap for deaf and hard of hearing high school students lies in the lack of a transition program/counselor or coordinator at the HCDB. (See other service gaps identified in "Summary" item 5, above.)

Coordination among all service agencies and advocacy and consumer groups involved with deaf and hard of hearing high school students needs to be improved. The delivery of vocational rehabilitation services needs to be coordinated among the service agencies. Whether or not this coordination may result from or be enhanced by the creation of a separate branch for the deaf and hard of hearing is an issue sure to be examined by the Department of Human Services. Referrals to private providers for transition services may also be a possibility. At the least, coordination needs to be improved between the HCDB, the Department of Education, and the DVR. Various steps can be taken towards this goal. For example, an informal working group can be set up with members from each agency to enhance cooperation and timely interdepartmental communication. In addition, the HCDB should develop a coordinated plan to assist its students and any other deaf or hard of hearing students in other schools statewide to make the transition to the work force. This should include an established and expedited process for referrals to the DVR for vocational rehabilitation services. Naturally, all agencies involved should cooperate in the development of this plan.

It should not be surprising that any such coordinated plan may consider either increasing the number of staff or instituting more intensive and extensive staff training to improve the efficiency of service delivery. The general shortage of transition staff who are fluent in sign language requires the same dual approach of aggressive new staff recruitment and development and training of existing staff. (See "Need for Qualified Deaf or Hard of Hearing Staff" above.)

1. Caveat when interpreting the phrase "all groups consulted": The Aloha State Association of the Deaf chose to respond to the Bureau's survey via open-ended written responses rather than by answering specific questions. Thus, its response is not directly comparable to those of the other groups consulted.

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