An evaluation of an area-wide message relay program: national implications for telephone system access.
Because of their disability, deaf people experience economic and social barriers as they interact in a hearing society (Pimental, 1980). A deaf person is functionally defined as someone whose hearing is so seriously impaired that he or she cannot understand speech even with a hearing aid (Shein and Delk, 1974). For example, although the capacity to use a telephone is a convenience most people take for granted, deaf people cannot use a standard telephone. Further, their inability to hear often results in problems learning English, a decreased potential for independent living, and underemployment (Torkelson and Lynch, 1979).
A principal focus of the rehabilitation process has been to enable deaf people to enter or return to competitive employment (Mowry, 1987; Watson, 1985). This typically has involved helping them develop job-seeking skills, providing them with supportive services (e.g., interpreters), training them in the use of assistive devices (e.g., equipment to compensate for their hearing loss), and educating employers and co-workers about deafness.
In addition to their traditional mission of preparing clients for competitive employment, vocational rehabilitation counselors have placed a greater emphasis on helping clients develop independent living skills (Lorenz, 1982). Independent living services include teaching personal grooming, managing a budget and banking, using public transportation, food shopping and preparation, clothing care, and driver's education. In contrast to traditional vocational rehabilitation services, independent living programs are more likely to be appropriate for low-achieving deaf clients (i.e., those who function at the lower end of the spectrum of vocational and social skills). Although the supply of rehabilitation counselors with the ability to communicate in sign language has grown, the increased number and diversity of deaf clients seeking assistance often has made it difficult to locate appropriate and accessible programs for them (Danek, 1986).
One approach to widening the range of services for deaf persons is a community-based service center. These centers function as mechanisms for increasing the accessibility and coordination of existing programs. An accessible and coordinated system can allow a variety of organizations to assist deaf persons. However, despite their potential as rehabilitation resources, little is known about the characteristics of these programs. Klinefelter (1986) conducted a rare national survey of community-based service centers for deaf people. He reported that there are 200 of these centers, which offer services such as advocacy, training, information and referral, counseling, and distributing assistive devices (e.g., visual smoke alarms). Although Klinefelter (1986) provided a useful general overview of these programs, rehabilitation planners and counselors who are considering establishing them in their communities will require more detailed information. This paper reports the results of a study of one community-based service center for deaf people located in a mid-Atlantic city. Discussion focuses on findings that can assist rehabilitation professionals develop these programs.
Since November 1982, this community-based service center had served a city and three contiguous counties. This service area had a population of approximately 500 thousand people. This population was 70% white, and had a median household (i.e., all persons who occupied a housing unit) income of $18,000 (U.S. Department of Commerce, 1982). Deaf clients accessed all the center's services (described below) in two ways. The first way was to use a telecommunication device for the deaf (i.e., TDD). A TDD enables a deaf person to communicate by telephone. The TDD is a small machine similar to a typewriter that is attached to a regular telephone. For a person to use a TDD, the location they are calling must have a similar device. A person communicates by typing on the machine's keyboard. This message then appears on a small electronic display screen on the TDD at the other end of the telephone line, or on paper if that TDD is connected to a printer.
The second way clients accessed all the center's services is to visit the center (i.e., walk-in), and communicate in sign language with a staff person. Generally, clients who visit the office do not have access to a TDD. Hearing clients can access all services by telephone. The center's services include information and referral, help in locating interpreters, special equipment rentals, problem resolution assistance (e.g., mediating landlord-tenant disputes, help with billing problems), and message relays. As shown in Figure 1, message relays are performed by a hearing service provider who conveys conversations between two deaf people or between a deaf and a hearing person.
Initially, the center operated six hours a day, five days a week with one full-time professional position. This full-time position required fluency in American Sign Language (e.g., state interpreter certification), and experience providing human services to deaf people. The program's operating hours and personnel level have increased incrementally since it was established. When this study was conducted, the center operated Monday through Friday for eight hours a day with a 24-hour answering machine that provides information about who to contact for emergencies. Employees included two full-time professional positions; at least one student intern either from a nearby school of social work or from an interpreter training program; and a varying number of part-time volunteers (usually three per month for about 10 total hours each).
The center's operating budget for its first year was $12,000 and its budget for 1989 was $36,000. The program was administered and funded by the local United Way, and housed in its main office. Periodically, additional funds for special projects were donated by local service organizations (e.g., Lions Clubs), individuals, and businesses. A committee consisting of deaf consumers, service providers, and representatives from local service clubs advised the center. The committee's functions included identifying emerging needs, and reviewing program policies and procedures.
Data and Method
Data are from the center's client data base. Information for the 13-month period from January 1989 to January 1990 inclusive was collected to allow for seasonal and other cyclical fluctuations in service utilization levels. During a deaf person's initial contact with the center, an individual computer file was established. This file was updated each time the client used the service. Every client was assigned a unique identification number. Throughout all phases of this study only identification numbers were used to ensure client anonymity. Separate files were not maintained for hearing clients, but selected information (e.g., number of calls, purpose, time) was collected and stored.
Files for deaf clients contained two basic types of data: demographic and service-related. Demographic information included gender, age, race, and type of government assistance currently being received. Service-related information included the time of the contact; the purpose of the contact (e.g., housing-related); services provided (e.g., message relay, information); total time spent with the client; and how the client accessed the service. These data were a census of client characteristics and service activity during the study period. Since these data are not a sample, statistical results are definitive rather than inferential for the center during the study period.
The center's client data base contained 258 active files, which represented all deaf clients served at least once since it was established. One hundred and eighty-three clients contacted the program during the study period. A client contact is the period during a TDD, voice call, or office visit. Table 1 compares total client contacts made during the study period. Sixty-six percent
TOTAL CONTACTS BY ACCESS METHOD AND TIME WALK-IN TDD VOICE TOTAL AM 39% 44% 42% 43% (335) (1,767) (510) (2,612) PM 61% 56% 58% 57% (533) (2,247) (700) (3,480) TOTAL 868 4,014 1,210 6,092
of all contacts were by TDD callers, 14% by walk-ins, and 20% by voice (i.e., hearing) callers. More contacts were made from noon to 5 P.M. (56% for TDD, 61% for walk-in, 58% for voice).
TDD calls required an average of 11 minutes per contact, and walk-in contacts an average of 30 minutes. The average TDD caller contacted the program about five times a month, and the average walk-in about three times a month. (As noted earlier, individual files are not maintained for hearing clients. Therefore, it is not possible to calculate the number of contacts per month for the average hearing caller.)
Two approaches were used to analyze seasonal or monthly trends in program activity. The first approach ranked each of the thirteen months according to total actual contacts. However, variation in total personnel hours occurred during the study period because of vacations, sick leave, and staff turnover (mean = 110.83 hours per month, S.D. = 26.37). Consequently, the second approach standardized total actual contacts in each month by holding total personnel hours constant. This second approach provided "adjusted ranks" for monthly service contacts, or the ranks that would have occurred if total personnel hours had been the same (i.e., the mean of monthly personnel hours for the period) during all months.
For example, January 1989 had 38.27 actual personnel hours. The mean total personnel hours for all months during the study is 110.83. Therefore, 110.83 divided by 38.27 equals 2.90. Then, TOTAL CLIENT CONTACTS BY MONTH
Actual Adjusted(a) Month Contacts Rank Contacts Rank September 591 1 485 10 June 573 2 516 6 July 566 3 516 6 August 558 4 536 5 January '90 541 5 611 2 May 531 6 547 4 October 525 7 399 12 December 508 8 625 1 April 451 9 478 9 November 420 10 437 11 March 400 11 500 8 February 323 12 388 13 January '89 205 13 595 3
(a)Adjusted to reflect number of contacts and rank if total personnel hours was 110.83, which is mean total personnel hours for the 13-month period.
2.90 is multiplied by total actual service contacts for January 1989 (205) to obtain an adjusted total of 595. The results of both approaches are summarized in Table 2. The months of January 1990, and May, June, and August 1989 ranked in the top six of both lists. February 1989 ranked in the bottom three of both lists. A service is the action or actions taken during a client contact. Each client contact, therefore, consists of at least one service request. Client contacts resulted in the provision of 9,371 services during the study period. Services provided during this period were as follows: 8,021 message relays, 856 information and referrals, 241 instances of problem resolution assistance, 199 requests for help in locating interpreters, and 54 equipment rentals.
Table 3 compares selected characteristics of deaf clients who walked-in with deaf clients who used a TDD to contact the center. Compared with TDD clients, walk-in clients were more likely to be males (52% versus 29%), younger (62% are less than 40 years old versus 49%), and members of a minority group (54% versus 17%). Table 3 also compares the type of government assistance being received. Government assistance was categorized as either "entitlements" or "social insurance." Entitlements include Aid to Families with Dependent Children (AFDC), Supplemental Security Income (SSI), and food stamps. Social insurance benefits include Veterans Benefits, Social Security Disability, and private insurance. Although most of the center's clients received entitlements, walk-in clients were more likely than TDD clients to receive these benefits (79% versus 65%). [TABULAR DATA OMITTED]
Table 4 summarizes client service requests. These requests were categorized according to purpose (e.g., individual and family life, housing, and legal). The most common reason for a service request was "Individual and Family Life." This category includes message relays, information, and problem resolution assistance related to areas such as school, entertainment, transportation, and routine communications between friends and relatives. TDD and walk-in clients used the center''s services for different reasons. Walk-ins were more likely than TDD users to contact the program for housing-related reasons (14% versus 4%), and for continuing financial need-related reasons (16% versus 2%).
Table 4 PURPOSE OF SERVICE REQUESTS (PERCENTAGES) PURPOSE WALK9-IN TDD Consumer-Related 9 12
Continuing Financial Need (Finan, Assist.,
Current Employment) 16 12
(Police, Fire, Medical) 0 8 Day Care 1 1 Housing 14 4
Individual and Family
Life (School, Entertainment, 22 22
Personal, Trans, Repair)
Insurance 6 2 Legal 4 2 Medical Appointments 5 10 Non-Medical Appointments 5 9 Unemployment 8 5 TDD 1 1 Other 9 2 Total 100 100
Finally, Table 5 compares 1989 program service levels with those from 1983. During the period, message relays grew from 2,100 to 8,021, or about three hundred percent. Problem resolution assistance grew by approximately one hundred percent. Information and referrals decreased 20%, and interpreter coordinations decreased 25%. Demographic characteristics of the center's client population changed little since it was established. During its first five years of operation, it served a predominantly female (more than 60%), white (more than 77%) clientele. About half of these clients were 40 years old or less.
Table 5 [TABULAR DATA OMITTED]
Because there is a lack of data about community-based service centers, it is difficult to determine the extent that other programs and their clients differ from the center described in this study. Consequently, generalization of these findings to other programs should be made with caution. The following discussion focuses on issues related to the type and level of services delivered by this center, and the number and characteristics of its clients.
Type and Level of Services Delivered
Comparison of 1989 service levels with those from 1983 (Table 5) indicates that message relays and the information and referral were the most frequently delivered program components. Moreover, the number of message relays performed grew almost three-hundred during this period. Consequently, when planning a community-based center, rehabilitation professionals initially should include message relay and information and referal components. They also should anticipate a rapid growth in the number of message relays requested, and the need to add interpreter services and problem resolution assistance.
Personnel needs and estimates of service activity levels are difficult to determine without data about the relative time needed to serve TDD, walk-in, or voice access clients. This study provides time factors for guiding these decisions. These time factors can be used by rehabilitation personnel to compute the approximate number of clients that can be served during any given period. Moreover, if a level of unmet need can be quantified (e.g., number of clients getting a busy signal or waiting for walk-in service for more than a half-hour), the additional personnel time required to provide services can be determined. This study also provides a beginning indication of peak service times that can be used to schedule staff vacations, and to identify preferred volunteer periods.
Number and Characteristics of Clients
Despite a variety of outreach efforts, the number of individual deaf clients served by this center has stabilized at approximately 200 clients a year. Based upon widely used prevalence rates, (i.e., Shein and Delk, 1974) there were about five thousand deaf people living in this program's service area during the study period. Even if this number is used as a rough indicator of the size of this area's deaf population, there is a very large difference between the estimated number of potential clients and the number served since the program was established. Possible reasons for this differential include (1) the inaccuracy of a prevalence rate of 0.873% of the general population being deaf; (2) an inability to reach a significant portion of deaf people during the last five years; (3) the unwillingness of deaf people to use the program, despite knowledge of it; and (4) a lack of need for the center's services. Therefore, rehabilitation professionals should be prudent when developing initial estimates of the need for a center in a particular community.
Another notable finding is that TDD access clients and walk-in access clients represented two distinct sub-groups of deaf people. Clients who use the walk-in access component of the program were more likely than TDD access clients to be younger males who are members of a minority group. Also, walk-in clients could be poorer than TDD users, since they are more likely to receive entitlements, and to request services for continuing financial and housing-related reasons. The employment and educational problems of deaf people (Shein and Delk, 1978), and of minorities in general (Parrillo, 1985), are well documented. Consequently, with their double minority groups status, minority deaf people can experience more severe underemployment and undereducation than non-minority deaf people (Callaway and Tucker, 1986; Taft, 1983).
Having a significant proportion of clients who are poor suggests the need for these centers to coordinate their services with local departments of social services and with local Social Security offices. For example, these agencies can be encouraged to conduct on-site eligibility determination. Not only would on-site eligibility determinations reduce travel costs for clients, they can provide an opportunity to educate human service workers about deafness. Furthermore, center staff can provide interpreter services, and help reduce costs for cooperating agencies.
There are few empirical estimates of the proportion of deaf people who own or have access to TDDs. One state-wide study estimated that less than half of that state's deaf people, and only 15% of those with lower incomes, have a TDD available (Virginia Department for the Deaf and Hard of Hearing, 1987). Another study of former clients of a rehabilitation center reported that 7.7% owned a TDD (Stewart and Watson, 1987). Moreover, the low utilization of this center's device rental component (see Table 5) seems to suggest that some deaf people either will not or cannot use a TDD when they are available at low cost (i.e., one dollar per week rental fee).
TDDs are not technological panaceas for bridging the worlds of deaf and hearing people. Accordingly, there is a need to consider both deaf people's capacities to afford telephone service, and their abilities and desires to use these devices. For deaf people unable or unwilling to own TDDs, community-based service centers with walk-in access components must be available. Ironically, without walk-in access, programs designed as a solution to accessibility problems can be inaccessible to some deaf people.
Rehabilitation counselors are being asked to deliver a wide range of services to prepare deaf clients for competitive employment, and more recently, to help them develop independent living skills. Accordingly, when providing services to deaf clients, vocational rehabilitation personnel must deal not only with the physical limitations of their disability, but also with the linguistic, educational, psychological, and social effects of their hearing impairments (Vernon, 1980).
Given current limitations in available funding for social services, state vocational rehabilitation agencies could find it difficult to meet the needs of an increasingly diverse group of deaf clients by relying solely on Shein's (1980) recommendations. These recommendations include developing a model state plan for the rehabilitation of deaf clients, and hiring state coordinators and rehabilitation counselors for deaf people. This paper describes a detailed study of one community-based service center for deaf people, and provides previously unavailable information to rehabilitation professionals seeking to widen the range of programs for deaf people.
As alternatives or complements to Shein's (1980) recommendations, community-based service centers can function as mechanisms for increasing the accessibility and coordination of existing programs. These centers can (1) perform message relays; (2) locate interpreters; (3) provide training to employers and co-workers about deafness; and (4) encourage a wider range of organizations to provide services to deaf people, such as departments of mental health, family service agencies, and the Internal Revenue Service. Such services are essential for many deaf people to obtain employment and to live independently.
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