Communicating with persons who are deaf: some practical suggestions for rehabilitation specialists.

Communicating with Persons Who Are Deaf: Some Practical Suggestions for Rehabilitation Specialists

General caseload counselors, vocational evaluators, work adjustment trainers and job placement specialists are occassionally called upon to provide services to individuals who are deaf. Deafness is defined as a condition in which the auditory channel is nonfunctional as the primary modality for language and learning. Because rehabilitation specialists typically do not use sign language and/or are not familiar with strategies that can enhance communication with deaf persons, personal interaction between the two can be limited. The information provided will offer basic and practical strategies for facilitating communication with deaf persons. These strategies are subdivided into those related to physical environment, and those involving personal communication.

Physical Environment

The physical environment can facilitate or hinder communication. Lighting, noise and telephone use are the germane elements of this discussion.

Since persons who are deaf rely on visual cues, appropriate lighting is a necessity. Rooms should be furnished with unflickering and nonglaring illumination. The light should be on the face of the speaker, and not in the eyes of the deaf person. A common error made by hearing persons is to stand or sit in front of a light source (e.g., with one's back to a window). This creates a silhouette effect that results in masked facial expressions or lip movements (Birch, 1975; Gildston, 1973). Another common error is to turn lights off when showing films or video tapes. This impedes deaf individuals' abilities to see the faces of persons making comments about the film or to see interpreters clearly. A solution to this problem is to keep some lights on or to open a window curtain (Kampfe, 1984).

Noise typically interferes with the ability to understand speech (Birch, 1975; Gengel, 1971; Tillman, Carhart, & Olsen, 1970). Mechanical equipment and building noises, movement of chairs, background music, and buzzing lights can all impede speech discrimination. This is especially true for persons with sensorineural hearing losses (Gengel, 1971), and for those wearing hearing aids (Stassen, 1973). A sensorineural impairment involves a loss of both loudness and clarity of speech. The greater the loss, the more distortion (Leavitt, 1984). The distortion becomes even greater in a noisy environment. Hearing aids amplify room noises in addition to speech sounds. This amplified noise results in a masking of speakers' voices (Leavitt, 1984).

Noise can be controlled by avoiding rooms that are large and echoing or that have hard, smooth surfaces (Gelfand & Hochberg, 1976). The noise levels of these and other rooms can be lessened by covering surfaces such as walls, ceilings, floors, furniture and windows with noise absorbing materials such as draperies, textured wallpaper or plaster, upholstery, carpeting and/or acoustical tile (Stassen, 1973). Mechanical noises can be minimized by removing, padding or oiling equipment. Since it may not be reasonable for rehabilitation specialists to attempt this, other strategies may need to be employed. For example, it may be helpful to seat deaf persons from sources of noise or to select rooms located away from heavy traffic areas. Since this is not always possible, notices can be posted requesting silence and/or coworkers can be informed, personally, of the need for quiet halls outside the rooms being used (Kampfe, 1984).

Many rehabilitation specialists contact their clients via telephone. This may create a problem in communication because the telephone is typically difficult or impossible for deaf persons to use. There are several strategies that can alleviate this problem. Using a telecommunication device, sometimes called a TDD or a TTY, is perhaps the most ideal strategy at the present time. This device allows the speaker and the deaf person to communicate over regular telephone lines by typing messages to one another (New technolgoy, 1988). The advantage of the TDD is that it does not require a third person to interpret messages. This results in greater potential for confidentiality and less potential for miscommunication. The disadvantages are that telephone calls typically take longer than calls with a regular telephone, both persons must have a device, and purchasing one may be impractical for specialists who seldom work with persons who are deaf. If there is a likelihood of interface with deaf persons, however, a TDD should be available. As legislative bodies begin to recognize the need for TDDs, new state laws may begin to require that these devices be made easily accessible to persons with deafness. For example, the Rhode Island General Assembly has passed a bill that requires the Public Utility Commission to provide deaf persons with such devices at no additional cost to the consumer (Bond, 1986).

Another alternative is a telephone relay service. A relay service is typically located in one central facility equipped with one or more telecommunication devices. Hearing speakers call an operator at this facility and the message is relayed, via a TDD, to deaf persons or vice versa (New technology, 1988). The advantages of this service are that hearing persons are not required to own a TDD, and deaf persons who have TDDs are able to call almost any telephone number. The limitations are that these systems do not exist in many locations or are available only for emergency purposes, and flow of communication and confidentiality may be jeopardized because of the need for a third person (operator).

Because relay services are not available in many areas, it may be necessary to call family members or friends of the deaf person. When doing this, several strategies can be used to facilitate personal and direct communication in spite of having to rely on a third person. If clients are not available, a short message should be left for them to return the call. This is preferable to leaving extended messages. When communicating with deaf persons via a third party (i.e., friend), hearing persons should speak as if talking directly to the deaf person rather than to the friend. For example, instead of saying, "Tell him that I'd like to see him tomorrow," the speaker should say, "I'd like to see you tomorrow." The advantage of calling friends or family members is that it requires neither the deaf person nor the specialist to own a TDD. The disadvantages are that confidentiality is sacrificed, free communication may be stifled, and misinterpretation or miscommunication may occur.

New and more practical telephone communication aides are presently being developed. For example, researchers at Bellcore have built a prototype system called DEAFNET. With this system, the individual who is deaf will be able to type messages into a TDD. A computer, located at the telephone company's central office, will translate these into verbal messages using a speech synthesizer. Although this system remains in the prototype stage, it has the potential to facilitate communication between deaf and hearing people. The advantages of the system are similar to those or present telephone relay systems (e.g., the nonhearing impaired persons will not need a TDD, and the hearing impaired person will have access to nearly all telephone numbers). In addition, the system will offer confidentiality, since a third person will not be required, and the system will operate automatically from town to town and state to state, allowing accessibility to many designations (New technology, 1988).

There are a variety of other assistive devices that are considered to be auditory trainers, but than can be used for other purposes. Because they are expensive and are practical only for groups of individuals, this discussion will be limited to brief descriptions of each. Infrared systems are mounted in specific rooms and emit signals via invisible light that can be received by receivers worn by deaf persons. Freefield FM systems pick up specific speakers' voices and send radio signals to deaf persons' personal hearing aids. Audio loop systems are installed in specific rooms. These transmit signals through wires around the room and either hearing aids or other special receivers can pick up the signal for the deaf person (Middleton & Ekhami, 1987).

Making these adjustments in the physical environment can sometimes cost money, but many of the suggesetions are of minimal or no cost. Since the environment has a strong impact on communication between deaf and hearing individuals, such adjustments are vital to quality services to the deaf population.

Personal Communication

In addition to strategies to control the physical environment, there are strategies that can facilitate direct personal communication. Most of theses are easily implemented. These include techniques that can enhance use of interpreters, speechreading, use of residual hearing, and group work.

In all cases, rehabilitation specialists should respect clients' choices of methods of communication. Persons who are deaf may use either speechreading or one of many methods of sign language as their primary method of communicating and learning. If speechreading is used, they may prefer to interact directly with service providers or they may wish to use an oral interpreter. If manual communication is the method of choice, it is preferable that specialists sign for themselves. Since this is not always feasible, an interpreter can provide a valuable communication link.

Persons who have never worked with interpreters are often confused about these valuable professionals' roles. Basically, they act as a communication link between persons with hearing impairments and hearing individuals (Hayes, 1984). Simply, they can be thought of as the ears and, if applicable, the voices of persons with a hearing impairment (Kampfe, 1984). Interpreters typically sit directly beside the speaker (Hayes, 1984) and use whatever method of manual or oral communication their clients use. If necessary, they are able to read the signs of deaf persons and verbalize them to persons who do not sign. When using an interpreter, specialists should speak directly to deaf persons. For example, rather than looking at the interpreter and asking, "How does he feel today?", the speaker should look directly at the client and ask, "How do you feel today?"

Interpreters function under a strict code of ethics that requires absolute confidentiality regarding their client's lives. It is, therefore, inappropriate to ask them anything about the persons they serve. The code also requires that interpreters repeat everything that is being said, including "side comments" or telephone conversations received by hearing persons (e.g., specialists) during an interview; so when using an interpreter, specialists should be aware that anything that is said will be repeated to the client.

Advantages of using interpreters are that they have the pontential to provide fast, accurate communication that is otherwise impossible between deaf signing persons and hearing nonsigning persons. They are also able to aide minimal language deaf individuals (i.e., those who do not have any fluent form of communication) in being understood (Maher & Waters, 1984). These services allow deaf persons to access many professionals rather than only those who are fluent in communication with deaf persons. Other advantages identified by interpreters in a study by Maher and Waters (1984) are that interpreting services can provide safeguards against miscommunication, offer counselors insight into deafness, help deaf clients feel at ease in a situation where they might otherwise feel uncomfortable, and facilitate clients' abilities to "open up" because they trust the interpreters.

This last item might actually be a disadvantage. If clients rely too heavily on interpreters for comfort, this might interfere with client/specialist relationships and/or create a sense of dependency on interpreters. Other disadvantages reported by counseling professionals are that clients may be unduly influenced by interpreters, the meaning of some communication may be lost, eye contact between specialists and clients will be jeopardized, emotional expression between the counselors and clients may be stifled, discomfort may occur because of the presence of a third party, and confidentiality may be sacrificed (Maher & Waters, 1984). Disadvantages reported by interpreters include the danger of interpreters being unable to maintain an objective and impartial attitude, clients' feeling reticent to fully disclose information in the presence of interpreters, unqualified interpreters providing miscommunication that may mislead counselors or clients, and clients or counselors misusing interpreters as therapists. These disadvantages seem to offer arguments against the use of interpreters, however, if qualified registered interpreters are used, many of these problems are minimized (Maher & Waters, 1984). Certainly, the ideal is for rehabilitation specialists to sign themselves, but if this is not possible, an excellent alternative is to use interpreters.

Selecting an interpreter is critical. It cannot be assumed that because hearing individuals use sign language, they are also interpreters; or that all interpreters are appropriate for all persons who are deaf. Qualified interpreters can be found by contacting the local, state or national organization of the Registry of Interpreters for the Deaf; local or state organizations of the deaf; local or state educational programs for the deaf; or colleges that provide interpreter training (Hayes, 1984).

Regardless of whether specialists use interpreters, sign for themselves, or use speech only; it is vital that their lips and facial expressions be seen distinctly. This is particularly true if sign language is not used. Speakers should face hearing impaired persons directly, since it is much more difficult to speechread from the side (Birch, 1975; Stassen, 1973). Eating, chewing gum, placing objects in or near the mouth, placing one's hands over the mouth or touching the face interferes with communication. Long hair and beards may also hide important facial clues and mouth movements. Other disruptive behaviors are speaking with one's back to hearing impaired persons (Birch, 1975; Gildston, 1973), moving around while speaking (Gildston, 1973) looking down at notes or forms, or holding papers in front of the face when reading them to clients (Birch, 1975; gildston, 1973).

Consideration should be given to the facilitation of speechreading and use of residual hearing. Maximum use of hearing aids is an important factor here. Persons who are deaf typically wear aids to enable them to utilize any auditory capacity that might remain (Skinner & Shelton, 1979). Specifically, aids enhance speechreading, speech production and awareness of environmental clues. Individuals wearing aids should be seated in positions that facilitate this (Northcott, 1973). It is advisable to ask them where they want to be located to enable them to use both their aids and their vision to the best advantage. Distance from speakers is also an important consideration. As the speaker moves away from the listener, the ability to hear and to understand speech decreases many fold (Birch, 1975; Gildston, 1973). A general rule might be, "the closer the better."

Clear articulation is useful strategy. Increasing the loudness of the voice does not typically help the person's understanding. Speaking at moderate speeds, enunciating clearly and lowering the pitch of the voice are more appropriate techniques. When using these techniques, the mouth motions should never be overemphasized, since exaggeration makes speechreading more difficult (Birch, 1975; gildston, 1973).

Situational clues regarding the topic of conversation can facilitate both speechreading and the use of residual hearin. Natural, unexaggerated gestures of the hand and face such as pointing to an object, walking toward it, glancing at it or touching it are excellent methods by which to give situational clues (Birch, 1975; Berger, 1972; Stassen, 1973). The use of facial and body expressions to show feeling is also helpful. Since body language performs a similar function as tone of voice, speechreading is much easier when expressions "match" the conversation (Berger, 1972). Without them, persons may understand the words spoken, but misinterpret their meaning.

Rehabilitation counseling and/or training occasionally requires group interaction. Group work with several people talking at one time can create speech discrimination (Gildston, 1973) and speechreading problems. Group leaders can alleviate these problems by repeating important points and by asking persons to talk one at a time and speak slowly and clearly (Foster, 1987). Leaders can look toward persons who are speaking or make gestures toward these speakers to give deaf persons clues as to where to look (Stassen, 1973). Individuals with hearing losses can be allowed to sit or stand in positions that offer optimal viewing of all persons with whom they are required to communicate. Seating adjustments should be made as unobtrusively as possible to avoid overemphasizing the hearing impairment (Kampfe, 1984). A semicircular seating arrangement is useful for this purpose, and can be effective for both large and small groups.

Durin group of individual work, specialists should be alert to any signs that deaf persons are misunderstanding what is being said. A slow positive head shake or a blank stare from the individual may be a signal that the statement has not been received or understood (Birch, 1975). Strategies for assuring understanding are: encouraging individuals to ask for repeats when they are having trouble receiving or understanding what is said (Gildston, 1973); agreeing with clients on a prearranged signal that they can use when they do not comprehend the conversation (Kampfe, 1984); rephrasing statements that are difficult to understand in their original forms (Birch, 1975); rephrasing whole statements rather than single words (Birch, 1975; Gildston, 1973); or discreetly asking other speakers to repeat what has been said.

In group and individual training sessions, it is helpful to write important phrases or words on the chalkboard or paper. Doing this will inform deaf persons of the topic of conversation and lessen the likelihood that major points will be missed (Birch, 1975; Gildston, 1973; Northcott, 1973; Stassen, 1973). When using the chalkboard, speakers should not speak until they have finished writing and can turn around to face the group (Birch, 1975; Gilston, 1973). After writin, it is best to repeat the written statements verbally. Persons with hearing impairments can then associate lip movements with the words and phrases to be discussed. Another method of familiarizing them with important terminology is to discuss terms and their meaning prior to the training session. Seeing and hearing the vocabulary in advance helps persons who are deaf follow discussions or presentations (Gildston, 1973). In addition to these strategies, pictures and other visual aids can provide clues and or clarify points (Birch, 1975; Gildston, 1973; Stassen, 1973).

Specialists should remember that persons who are deaf cannot concentrate on taking notes and speechreading simultaneously. It may be necessary, therefore, to wait for these individuals to look up before speaking. It this interferes with smooth presentations/meetings, specialists can supply copies of lecture or meeting notes and/or make arrangements with normally hearing persons to share notes (Birch, 1975; Foster, 1987). If the client's major method of communication is manual communication, and specialists do not sign, the preferred strategy is to provide an interpreter. This individual can assure that messages are received, clients' questions are answered, and discussions or presentations are not slowed down unnecessarily. Even with an interpreter, deaf individuals may wish to have copies of notes to enable them to concentrate on speakers.

In addition to using the above strategies, rehabilitation specialists should be aware that with deaf clients communication may be slower. Patience is vital because additional time and effort may frequently be required (Foster, 1987). It is sometimes helpful to schedule a little extra time when working with deaf persons to avoid frustration due to this slower communication.

These strategies that facilitate personal communication between deaf and hearing persons are relatively easy to implement, and they offer tremendous opportunity for rehabilitation specialists to enhance their abilities to work effectively with persons who are deaf. In addition to improving communication itself, using them is a demonstration to clients that specialists understand their special problems and are willing to make adjustments to work with them.

Summary

Some of the services discussed here can be supplied by Deaf Service Centers. Most centers typically provide interpreting, information and referral to community resources, telecommunication relay systems, community awareness and advocacy. The larger centers might also offer recreation, adult education, assistance with housing, job seeking, and travel arrangements. Many have developed cooperative agreements with other community services such as social services, mental health services and vocational rehabilitation (Warner, 1987). Some may even provide counseling and mental health services. Although these centers are not available in all cities, they are available throughout the United States under a variety of names. They can offer a great deal of help to rehabilitation specialists in providing services to persons who are deaf.

Other valuable resources are the federally sponsored post-secondary programs for deaf persons. These are Gallaudet University, District of Columbia; the National Technical Institute for the Deaf at the Rochester Institute of Technology, New York; the St. Paul Technical Vocational Institute, Minnesota; Seattle Central Community College, Washington; the University of Knoxville, Tennessee; and California State University, Northridge, California. Programs for training interpreters are also valuable resources. These can be found in many states, and are typically associated with colleges and universities such as the University of Arizona, Tucson; Gallaudet University, District of Columbia; and Waubonsee Community College, Illinois. Training programs for rehabilitation counselors of the deaf can also offer information and perhaps consultation. They are located in colleges and universities such as the University of Arizona, Tucson; Gallaudet University, District of Columbia, Western Oregon State College, Monmouth, and Northern Illinois University, Dekalb. These and other resources are listed in the annual April issue of the American Annals of the Deaf. The journal provides names of these programs as well as their addresses and telephone numbers.

Specialists may find that service centers or special programs do not exist in their community. Many of the strategies suggested here can be implemented without the aid of a special community center. Most require little extra effort or expense and are relatively easy to adopt. Although they are basic, they are vital to communication with deaf persons. Implementing them can enhance the relationship between clients and rehabilitation specialists; and eventually result in facilitating the rehabilitation process.

References

Berger, K. W. (1972). Speechreading principles and methods. Baltimore: National Educational Press.

Birch, J. W. (1975). Hearing impaired children in the mainstream. St. Paul: Leadership Training Institure/special Education, University of Minnesota.

Bond, G. H. (1986). The Rhode Island TDD plan: A model. Journal of Rehabilitation of the Deaf, 19, 11-14.

Foster, S. B. (1987). Employment experiences of deaf college graduates: An interview study. Journal of Rehabilitation of the Deaf, 21, 1-15.

Gelfand, S. A., & Hochberg, I. (1976). Binaural and monaural speech discrimination under reverberation. Audiology, 15, 72-84.

Gengel, E. W. (1971). Acceptable speech-to-noise ratios for aided speech discrimination by the hearing impaired. Journal of Auditory Research, 11, 219-222.

Gildston, P. (1973). The hearing impaired child in the classroom: A guide for the classroom teacher. In W. H. Northcott (Ed.), The hearing impaired child in a regular classroom: preschool, elementary, and secondary years. A guide for the classroom teacher/administrator (pp. 37-44). Washington, DC: Alexander Graham Bell Association for the Deaf.

Hayes, J. L. (1984). Interpreting in the K-12 mainstream setting. In K. I. Dilka & R. I. Hull (Eds.), The hearing-impaired child in school (pp. 163-170). Orlando: Grune & Stratton.

Kampfe, C. M. (1984). Mainstreaming: Some practical suggestions for teachers and administrators. In K. I. Dilka & R. I. Hull (Eds.), The hearing-impaired child in school (pp. 99-112). Orlando: Grune and Stratton.

Leavitt, R. J. (1984). Hearing aids and other amplifying devices for hearing-impaired children. In K. I. Dilka & R. I. Hull (Eds.), Thehearing-impaired child in school (pp. 39-68). Orlando: Grune and Stratton.

Maher, P., & Walters, J. E. (1984). The use of interpreters with deaf clients in therapy. Journal of Rehabilitation of the Deaf, 17, 11-15.

Middleton, R. A., & Ekhami, L. (1987). A selective study of utilization of various assistive listening devices in schools, libraries, and hospitals. Journal of Rehabilitation of the Deaf, 21, 18-23.

New technology may offer easier comminication for persons who are deaf. (1988). ARCA News, 15(2), 6.

Northcott, W. H. (1973). A speech clinician as multidisciplinary team member. In W. H. Northcott (Ed.), The hearing impaired child in a regular classroom: Preschool, elementary, and secondary years. A guide for the classroom teacher/administrator (pp. 83-93). Washington, DC: Alexander Graham Bell Association for the Deaf.

Skinner, P. H., & Shelton, R. L. (1979). Speech, language, and hearing: Normal processes and disorders. Reading, MA: Addison-Wesley.

Stassen, R. A. (1973). I have one in my class who's wearing hearing aids! In W. H. Northcott (Ed.), The hearing impaired child in a regular classroom: Preschool, elementary, and secondary years. A guide for the classroom teacher/administrator (pp. 24-31). Washington, DC: Alexander Graham Bell Association for the Deaf.

Tillman, T., Carhart, R., & Olsen, W. (1970). Hearing and efficiency in a competing speech situation. Journal of Speech and Hearing Research, 13, 789-811.

Warner, H. C. (1987). Community service centers for deaf people: Where are we now? American Annals of the Deaf, 132, 237-238.

CHARLENE M. KAMPFE, Division of Rehabilitation Counseling, CB #7205, Department of Medical Allied Health Professional, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514.