Discerning characteristics and risk factors of people who are deaf and low functioning.

Persons who have a hearing impairment comprise the largest chronic disability group in the United States (Institute on Rehabilitation Issues, 1999). This heterogenous group of Americans includes persons with all degrees of hearing loss. Two categories commonly seen in hearing loss are hard of hearing and deaf. Persons who are hard of heating typically have a hearing loss ranging from mild to profound, without regard to age at onset. Individuals who are hard of hearing communicate via speech, with or without hearing aids. Deaf individuals are people who are unable to hear and understand speech. Their primary mode of communication is visual rather than auditory and may include some form of sign language.

Among the population that is deaf there is a vast amount of heterogeneity. There are those who are born deaf to parents who are hearing; those born deaf to parents who are deaf; are pre-lingually deaf, post-lingually deaf, and late deafened. Communication modes and styles also vary among people who are deaf. Modes and styles include American Sign Language (ASL), Signed English, Pidgin Sign English (PSE), Total Communication, and oral communication. Educational backgrounds of this group are also diverse. For students who are deaf, education may include state residential schools, public mainstreamed schools, private residential schools, and private mainstreamed schools.

Additionally, there is a segment of the deaf population with the heterogeneity factors mentioned above, but with additional differences. This segment has often been referred to as low functioning deaf, underachieving, severely disabled, multiply handicapped, and minimal language skilled (IRI, 1999). Currently Low Functioning Deaf (LFD) is used more frequently. This term also includes people who are hard of hearing. It is difficult to determine the prevalence of persons who are classified as low functioning deaf due to the lack of a clear measurable definition for this group. A 1988 estimate by The Commission on the Education of the Deaf [COED] estimated that there are approximately 100,000 LFD persons. This number is derived in part from the fact that one-third of the pre-adult deaf population has an additional disability. These additional disabilities include learning, physical, mental, and developmental disabilities (Moores, 1996). In 1998, Watson estimated the number of persons who are deaf with secondary disabilities to be over 160,000. Even though secondary disabilities are common among LFD individuals, not all people who fall into the category of low functioning have a secondary disability, although some may have two or three. Also, someone who is deaf and has a secondary disability is not necessarily LFD.

Professionals working with this group agree that there are applicable characteristics (IRI, 1999) that can be used to identify people who fit into this population. Many characteristics seen among the LFD population reflect environmental or educational deficits rather than physical deficits (IRI, 1999). Lists of such characteristics are very similar and include communication, education, vocation, social adjustment, independent living and secondary disabilities. However, Long and Clark (Undated) report that rehabilitation and education professionals clearly identify communication deficits as "the hallmark characteristic" of this population. These insufficient social and interpersonal communication skills are often due to ineffective education and insufficient family support (NIDRR, 1994). Stewart (1971) describes these communication deficits as being "cumulative effects of experiential deprivation and under-education" (p. 97). Written and spoken English and communicating in sign language, expressive or receptive, is ineffective for many in this group (Larew, Long, & Mittal, 1992:93). Additionally, communication and language use differs between the workplace and home. One such example would be the word "break." At home this term involves destruction of property, while at work break means a short cessation from labor. The development of job-specific vocabulary, phrases, and signs is necessary for effective communication on the job.

These characteristics often cause LFD individuals to have a low social status in the Deaf community and to be labeled as failures by educational systems. Additionally, specific risk factors (Long & Clark, Undated), when present, put people who are LFD at a greater threat of being under-served, under-trained, underemployed and under-educated. Service providers are sometimes challenged when they must determine which individuals fit into this category. Some people seeking services and needing intense, long-term services clearly fall into the LFD population, while others are not so clearly recognizable. This unrecognized group often does not receive appropriate services (Cloyd, 2002 [personal communication]). Service providers, whether familiar with deafness or not, often lack the knowledge, skills, and abilities to serve or work with this population (IRI, 1999). Vocational training is often disrupted due to the impact of unaddressed issues stemming from characteristics and risk factors not previously identified.

Education is challenging for all persons who are LFD. As a whole this group holds low academic achievement with reading levels at or below fourth grade (Watson, 1998). Influential in language development and communication styles is the fact that forty percent of LFD individuals come from families whose first language is not English (Harmon, Carr and Johnson, 1998). This means a student would be exposed to spoken and signed English at school with a different language being spoken at home. Larew, et al. (1992:93) notes that math achievement levels for this group are below the third grade level. A consequence of these poor reading levels is sometimes misdiagnoses. Earnings are another area impacted by low reading and math scores. Hayward (1998) found that people with higher grade reading and math achievement levels earned two and three dollars, respectively, more than those with fourth grade reading and math levels.

There is also reduced ability among this group to obtain or maintain employment (Carlstrom, 1992). Ouellette (1986) also found a decline in employment rates after closure by VR. These vocational weaknesses result from inadequate training and changes in work situations (Glenn & Thorton, 1973; NIDRR, 1994). Watson (1998) explains that the inadequate education received by the majority of these individuals results in vocational deficiencies which contribute to lack of employment. Underdeveloped work attitudes, work habits, work goals, and job skills are experienced by these consumers. Long-term support is required in order to alleviate deficits preventing this group from experiencing successful employment (Larew, et al., 1992:93).

Developmental delays in social adjustment are also issues for people who are deaf and low functioning. Inappropriate behaviors, such as emotional outbursts or inappropriate gestures, in work and social gatherings brings ostracization in both hearing and deaf communities. A weakly developed sense of autonomy, low self-esteem, low frustration levels, lack of impulse control, and over protective parents or guardians (Carlstrom, 1992; Reiman, Bullis, & Davis, 1991; Watson, 1998) are all factors which contribute to these inappropriate behaviors.

There are also a wide range of deficits concerning independent living skills (ILS) for this populace. Deficits include basic money skills, time management, transitional ability, hygiene, health & nutrition, parenting skills, and medical management (Carlstrom, 1992; Reiman et.al. 1991; Watson, 1998). With training needed in so many ILS areas, LFD individuals need special support in order to achieve their maximum level of independence. This may help explain why Stewart and Watson (1987) found a poor quality of life among those who are deaf and low functioning.

This article will discuss how characteristics and risk factors can be assessed for people who are deaf and hard of hearing and have one or more functional limitations relating to employment and/or independent living. By identifying these consumers early on, efficiency in service provision is improved. Service providers can better plan in budgeting for services, prevent inappropriate training and loss of jobs, recognize early on that transitional support may be needed for successful closure and identify any needed training that is not necessarily vocational in focus.

Characteristics and Risk Factors

A primary characteristic regarded as pertinent among professionals is limited communication skills (IRI, 1999). Effective communication is often difficult whether it is conducted through reading, writing, speech, speech-reading, sign language or gestures (Long, 1996). Long, Long, and Ouellette (1993) identified three additional characteristics of LFD:

* English language level at or below the third grade level

* Poor social and emotional skills

* Transitional assistance or support needed to maintain employment or live independently

Risk factors identified for LFD by Long and Clark (Undated) can be grouped into three categories: personal attributes, social conditions, service delivery. The list below shows specific risk factors in each category.

Personal Attributes

1. Ethnicity
2. Substance Abuse
3. Secondary Disabilities

Social Conditions

1. Lack of Family Support
2. Lack of Appropriate Role Models
3. Low Socio-economic Status
4. Lack of Participation in Family & Cultural
Traditions
5. Discrimination Due to Deafness

Service Delivery

1. Lack of Interpreters
2. Lack of Access to Available Services
3. Inadequate Funding
4. Inappropriate Diagnosis

Method

Case files were reviewed on 50 students who were deaf (n=43) or hard of hearing (n=7) and had received services from a state vocational rehabilitation agency at a comprehensive rehabilitation facility in a small southern state. This facility was chosen because of a long standing agreement and commitment between the state vocational rehabilitation agency and the University of Arkansas Research and Training Center for Persons who are Deaf or Hard of Hearing. By working with the rehabilitation facility information was obtained from vocational rehabilitation services recipients at a localized facility. This allowed for both easy access to data and a more complete understanding of the facility itself, which helps with comprehending information found in case files and data analysis. Because of the sample size, generalizations to the general population of LFD cannot be made. However, the information in this study can be useful in seeing how characteristics and risk factors were assessed with a specific group, as well as gaining an understanding of which characteristics and risk factors were stronger in identifying those who are LFD.

Both quantitative and qualitative data were collected. Quantitative data were categorized according to specified variables in order to obtain demographic information and for developing a profile of the group being studied. Qualitative data were collected by thoroughly reading progress notes, evaluations, class reports, memos, training reports, and plans for training and employment. Additionally, 23 of the 50 participated in one-on-one interviews. These interviews included questions about training, services received, independent living, and employment.

Approximately 75% of the deaf and hard of heating students attending the rehabilitation facility during the designated five years were male. Eighty-eight percent of the total cases in the study were unmarried. A total of 28 Caucasians, 21 African-Americans and one Hispanic person attended during this time. The average stay at the rehabilitation center was ten months; the longest stay was approximately three-and-a-half years. The ages of students ranged from 17 to 44; the average age was nineteen. Less than 50% of the sample had held some type of previous employment before attending the facility.

Seven students were coded as hard of hearing, 42 as deaf, and one student as deaf-blind. Eleven clients had a secondary disability code. However, according to other case documentation and one-on-one interviews, some clients who did not have a secondary disability code did appear to have a secondary disability. Interestingly, people who have secondary disabilities may not always recognize them. For example, when asked about disabilities other than deafness, one man, who has post-polio syndrome and walks with a severe limp, stated, "NO OTHER. DEAF--ONE. THAT'S ALL." Other participants who had a secondary disability also reported deafness as their only disability.

The goal in reviewing case files and interviewing service recipients was to obtain additional data that is not recorded in the national RSA 911 database. Through this type of data collection specific information regarding services provided, social and emotional problems, evaluation findings, individual strengths and weaknesses, independent living skills, and vocational training could be documented and assessed in order to find patterns and differences in the characteristics and risk factors documented in the literature.

Characteristics Found

Communication

Signed and written communication skills need to be evaluated for every deaf or hard of hearing consumer served. Communication evaluations were not found in the case files, but references to mode and level or ability of communication could be found in most instances. Statements such as "significant deficits in sign language ability, picks up well on gestures, communication skills are very limited" and "was unable to express what he was feeling in sign or voice" conveyed that the consumers had difficulty with communication. Statements about written communication skills such as "could write complete sentences well, written description of picture was in ASL, could write how she felt but it was in ASL structure" and "written communication improving" conveyed written communication ability. There was no evidence that written communication evaluations were attempted for consumers who were severely limited in sign communication.

In addition to the case files, signed and written communication assessments were done on the 23 students interviewed. As a whole the interviewed group communicated well in sign language. A range of language use from PSE to ASL was found. Interviewees who had been mainstreamed in the public school system tended to use PSE, while those graduating from state residential schools used ASL. All interviewees used many initialized signs, but were often unable to spell the English word connected with that sign. Additionally, spelling of words were also difficult for many. One woman interviewee tried to spell maintenance but was able to spell only "M-A-I-..." then she signed "CLEAN." Two interviewees had Minimal Language Skills (MLS).

In order to evaluate written communication skills, the ability of interviewees to fill out the Participant Information Sheet was reviewed. Eight interviewees needed one-on-one help in filling ont the form. Because of his functional illiteracy, one man's spouse had to complete his form after he wrote his name, address and age. Three interviewees were able to recognize certain words such as address, work, SSI and rehabilitation, but were unable to understand what was being asked.

Reading Level

Case file information was reviewed to assess reading level. Sixty-four percent of the 50 students were found to have a reading level at or below the third grade. The number of students attending reading classes through the Adult Basic Education department also highlights the reading ability issues of this group. A total of 29 students attended these classes. Three students had case documentation of word recognition skills only: they were able to recognize some words in a sentence but not able to read and understand what the sentence meant. Half of the interviewees had great difficulty filling out the Participant Information Sheet (see previous section).

Social and Emotional Skills

Reviewing social and emotional skills involved two procedures with the case files. One procedure involved reading all case file data. Information that pointed to unstable social and/or emotional behaviors was documented. For example, statements such as "numerous problems with accepting responsibility for his own behaviors, tends to interrupt and get off the conversation topic, appeared quick to depend on others for decision making" and "social skills may be less developed than the average high school student" were used to recognize social and emotional problems.

Secondly, statements such as these were used to cross-reference students who had been referred to classes focused on improving social and emotional skills. Such classes deal with communication, problem solving skills, lack of emotional control, aggression, establishing a support system, behavior management, stress management, decision making, and self-esteem and were used as a guide in this study to discern social and emotional skills of consumers. These psychosocial classes are taken in conjunction with students' vocational training. Table 1 reflects the number of students who received training to assist in the development of appropriate social and emotional skills.

Employment Readiness Training (ERT) is considered a vocational training area because it focuses on students whose emotional and social skills are so poor that they cannot enter regular vocational training until their behavioral, social, and emotional skills are improved upon. Three of the 50 students reviewed participated in ERT.

Of the students who had been interviewed, only one person talked about losing a job since he left the training center, which occured because of uncontrollable emotions and behaviors. However, there were several interviewees who lacked problem solving skills. This was evidenced during the interviews as interviewees discussed problems that they did not know how to resolve or handle. These problems involved employers, employment, VR counselors, friends and money management.

Transitional Support

Transitional support, also known as transitional services, is defined in the Individuals with Disabilities Education Act (IDEA) as a coordinated set of activities for a student with a disability that focuses on the movement from school to post-school activities such as vocational training, employment, independent living, post-secondary education, and adult education. It is based on individual needs, preferences, and interests. Additionally, it brings in instruction, community experiences, acquisition of daily living skills, and related services. The category of "related services" is especially important for the LFD population because it potentially broadens the realm of service delivery (IRI, 1999).

Employment

To assess which students may have needed transitional support for employment, statements from case files such as "worked too fast which caused careless mistakes, has no work skills, worker characteristics were very poor, sleeps during class" and "lacked insight into vocational limitations and abilities" were used. These statements were documented by the counselors, teachers and vocational evaluators employed at the rehabilitation center who observed students during assessment, in the classroom and during work sample situations. Twenty-eight (56%) of the 50 case files reviewed contained at least one statement that reflected a deficit that could result in the need for transitional employment support. Additionally, 86% of the 50 students were recommended for classes that involved finding, obtaining, and maintaining jobs. This would indicate that evaluators, teachers, and counselors observed behaviors that reflected a lack of a knowledge of the world of work.

A need for transitional support was also determined through the interviews by looking at the number of interviewees who had lost their jobs within just a few months of leaving the vocational training center and the total number of jobs they held during the last five years. Fourteen interviewees fit into either one or both of those categories. Only one person of the 23 interviewees had never worked. The reasons for losing these jobs varied. Examples include not calling in, transportation, misunderstandings, poor job match, and quitting because they wanted to. With transitional support, problems such as these may be caught early enough to have less of an impact on job retention. Also, transitional support has been shown to be an essential part of working toward positive outcomes for people with disabilities (IRI, 1999).

Independent Living

Independent living is another area in which transitional support is often needed. When a person enters the rehabilitation center, evaluators quickly conduct an informal assessment of independence. If a person shows signs of lacking independent living skills (e.g, showing up late, poor hygiene, or getting lost), a general screening of everyday life skills is conducted. This screening device was from the Life Centered Career Educational Curriculum (LCCEC) used at the rehabilitation facility. A total of 44 (88%) students showed signs of low independence at the initial interview and were screened with the LCCEC screening device. Seventeen interviewees had difficulty with independent living skills, some of whom lived at home with parents. The skills with which they had the most difficulty included punctuality, work attendance, cooking, shopping, transportation, and money management. Some interviewees understood their own responsibility in their poor money management, while others did not. For example, one participant who lived alone stated that he sometimes did not have enough money because, "DEPENDS MY MOOD CARELESS SOMETIMES." In other words, he spent money when he should not. He was aware of and accepted responsibility for his money management. Another individual did not always have enough money because "friends" often came to him needing money. He gave money to the male "friends" because he was afraid of them. His female "friends" got money for the companionship he received.

Risk Factors Found

Personal Attributes

Ethnicity

This is assessed as a risk factor for reasons such as minority groups are often in a lower socio-economic status, English may not be the native language, cultural differences and the family may not know how to maneuver through the bureaucracy in order to obtain services. Case files revealed that 21 (42%) students who attended the rehabilitation center were African-American and one was Hispanic. Of the 23 students interviewed, nine (39%) were African-American.

Substance Abuse

Case files were reviewed for documentation on substance abuse. There was one person who was a recovering alcoholic. Interviewees were asked whether or not they had ever abused or misused drugs or alcohol. Three interviewees (13%) stated that they had abused or misused alcohol, but that they no longer drank. Since self-reports, especially about sensitive issues such as substance abuse or misuse, can be inaccurate, this percentage could be higher.

Secondary Disabilities

Evidence of secondary disabilities was looked for in two ways when reviewing the case files. First, through the secondary disability code. Eleven (22%) students had a secondary disability code. The second approach involved looking at the rehabilitation center's Individual Written Center Plan (IWCP). The IWCP includes a listing where limitations of the person are to be check marked. These items include both physical and mental limitations. There were 20 (40%) students who had limitations but did not have a secondary disability code. Limitations included things such as "left hand paralyzed" and "blind in right eye?' Because deafness is considered to be a severe disability, it automatically makes a person eligible for rehabilitation services, therefore secondary disabilities are often not coded or listed by eligibility workers.

Many secondary disabilities were evident when meeting the interviewees. Six of the interviewees had secondary disability codes listed in their files. However, there were five more interviewees who clearly had secondary disabilities such as blindness and Cerebral Palsy. Thus, 48% of the interviewees had a secondary disability and this may be a conservative estimate.

Social Conditions

Lack of Family Support

Interviewees were directly asked about family involvement and support during the interviews. Seven (30%) stated that they had no contact with their family of origin or that their family did not provide support of any kind. Five case files revealed a lack of family support through statements such as "there's been no contact with mother or siblings in years, foster mother rejected a request for a visit" and "search to locate siblings was unsuccessful."

Lack of Appropriate Role Models

The American Heritage College Dictionary (Jost, 2000) defines "appropriate" as suitable for a particular person, condition, occasion, or place and as fitting. In researching how many in this group lacked appropriate role models, several things were examined, the most important being deafness. Rarely does a child who is deaf have a deaf adult role model. The same is true for an adult who is deaf. A second variable that was examined was ethnicity. Finding an ethnically appropriate role model who is deaf is unusual. There were 22 (44%) students who were deaf and from an ethnic minority. Finally, people who are deaf and female also experience role model deficiency (Sheridan, 2001). Thus, 14 (28%) students lacked appropriate gender role models. For a person who is deaf or hard of hearing who fits into one of the variables listed above, the chance of finding an appropriate role model decreases significantly. Additionally, case files revealed a number of statements such as "there is an evident need for deaf adult role models" and "the client needs to be put in opportunities to observe deaf adults."

Because face-to-face encounters render different types of information than case files, there were additional variables observed during the interviews that indicated a lack of appropriate role models. In addition to deafness, ethnicity, secondary disabilities, and gender, education and living in rural settings were added. Education was selected because individuals who are mainstreamed rarely experience the opportunity to be around adults who are deaf. Living in a rural setting was added because often the interviewee was the only person who was deaf for a radius of 120 to 180 miles. Eleven (48%) interviewees had been mainstreamed in the public education system. Six (26%) lived in rural areas and could go days and/or weeks without contact with someone who was deaf.

Low Socio-economic Status (SES)

Because receiving VR services often depends on the financial situation of the applicant, it can be surmised that each individual receiving services is likely to be living in a low socio-economic situation. Because Supplemental Security Income (SSI) is based on current income, those interviewees who received SSI were categorized as having this risk factor. All interviewees who worked struggled with meeting monthly payments due to wages earned. Therefore, all 23 interviewees were determined to be of low SES. This was also found in Stewart and Watson's 1987 study.

In reviewing case files, there was no clear evidence of how many students were of a low SES. However, counselors documentation made references to inability to pay the rent or bills that were clearly connected to financial situation as opposed to skill or ability in money management was recorded as low SES. SSI documentation was not found in the case files.

Lack of Participation in Family & Cultural Traditions

During the interviews ten (43%) interviewees stated that they had contact with family members but did not participate in family activities. Also, there were several interviewees who talked about not having a social life in the deaf community. This was especially true for those living in rural settings. Case files had information such as "the client has limited and uneven cultural exposure" and "there's been a lack of socialization opportunities early in his education process" that gave insight into this risk factor.

Discrimination Due to Deafness

When talking to interviewees about discrimination, five (22%) felt that they had lost their jobs, had been given jobs beneath their abilities (underemployed), and had not been promoted or hired because of their deafness. One man felt he was being discriminated against due to his deafness because his supervisor refused to talk directly with him. The supervisor consistently used a non-signing peer to relay information or ask questions.

Service Delivery

Even though service delivery problems are perpetual for all people receiving services, it is important to note the specific service delivery issues that seem to impact the LFD population the most. By identifying those early on, chances can increase that the impact of some problems and challenges in this arena can be softened.

Lack of Interpreters

This was assessed as an on-going barrier, especially when the quality of available interpreters is considered. Locating qualified interpreters is often a challenge, even in larger cities. For people who have limited communication or for those living in rural areas the challenge is exacerbated because interpreters with the appropriate skills for these populations generally work and live in urban areas and it is costly to pay their travel expenses.

Lack of Access to Available Services

Several things need to be considered when reviewing access to services: geographical location, available transportation, personal level of functioning, quality of interpreters, and professional experience of service providers with persons who are deaf or hard of hearing. For individuals living in rural areas, accessibility to services is questionable for a couple of reasons. A key issue that is often missing among service providers is the speciality knowledge needed to work with people who are deaf and low functioning. Another potential barrier is availability of transportation. For people who live in rural areas and who are unable to drive or do not have a vehicle, getting to an agency for services can be a hardship.

For people living in cities access to transportation can also hinder receiving services. If a person does not own a vehicle or does not drive, he/she are always dependent on others for transportation. Not all cities have public transportation, and some cities have limited public transportation. Interviewees did not view taxi service as a viable option because of the expense. An individual's level of functioning impacts access due to an inability to understand and take advantage of all the possibilities. For individuals with family support this may not be as serious a barrier as for those who have no family support. However, if the family is supportive but is from another country they may not be familiar with language, services, or how to learn about services that are available to their family member who is deaf. This was, to some degree, the case for the one Hispanic person in the group studied.

Quality of interpreting services is also important because if an interpreter is not able to clearly convey information regarding eligibility requirements, paperwork, consumer responsibility, or deadlines, a person may miss opportunities that could help with personal independence. Finally, the service provider's knowledge of deafness is very important. If the service provider does not understand the special needs and circumstances of people who are deaf and low functioning, chances increase that appropriate services will not be accessible to consumers. In one way or another, every person in this study experienced at least one of these issues.

Inadequate Funding

This is another risk factor that is a perpetual problem for service provision agencies. Many organizations are vying for available monies, and many groups are lobbying to ensure legislation that will be beneficial for them. With all the competition it is difficult to find an agency, government or community based, that does not have to operate within the confines of a very limited budget.

Inappropriate Diagnoses

In assessing this risk factor it is important to carefully read through all medical information. In this study there were several students who had different diagnoses for the same problem. When this occurs, it raises questions as to whether appropriate services have been provided. One interviewee was uncertain about either diagnosis found in his case file. Information that raised the issue of inappropriate diagnoses were conflicting statements on medical evaluations. For example, in one file a medical note was found that recorded an impairment due to CP while another medical note indicated the impairment was due to an accident. Another case had a medical evaluation which noted an organic mental disorder while another doctor's note did not confirm the diagnosis.

Discussion

Characteristics

Communication: In spite of the fact that no formal communication evaluations were found in the case files, communication skills were assessed subjectively by evaluators and counselors at the center. Overall, the study group appeared to struggle with written communication much more than with signed communication. From the follow-up interviews it was assessed that, as a whole, signed communication was not a problem for the group, although there was a small percentage who had minimal sign language skills. The main communication deficits were in written communication. To help service providers assess this, an easy-to-follow initial interview form should be developed to be filled out by the person seeking services. The counselor needs to observe the person filling out the form and document challenges and help given to the person. Problems such as word recognition skills only, poor spelling, and inability to write home addresses without help are examples of problems that would need to be documented. This however, does not diminish the importance of assessing signed communication when conducting an evaluation.

Since written communication was such a challenge it was no surprise that reading levels were also low. This was clearly identified in case file records, and in the efforts of interviewees to fill out Participant Information Sheets. Therefore, it is imperative that when people who are deaf are required to fill out forms or applications, prior to assessment of their written communication and reading skills, assistance be provided to them in order to help with whatever questions they may have. This could help alleviate their frustration and embarrassment when trying to fill out forms or applications in a strange environment, with no one who signs to help them with questions. Again, documentation of this type of help will enable an identification of this person being at risk of functioning at a low level.

Social and Emotional Skills: A lack of social and emotional skills were also observed among this group, with over 50% needing some type of additional training in problem solving skills, stress management, decision making skills, behavior management, and self-esteem. In reviewing evaluations, psychological exams, and medical records, being attentive to statements that reveal a lack of social and emotional skills, such as the ones noted in this paper, will help service providers recognize people who are lower functioning and in need of additional/supplemental training.

Transitional Support: The number of students who needed transitional support in this study was close to 100%. Ways to recognize those who may need transitional services are the number of jobs held, length of time on jobs, why jobs were lost, punctuality to appointments, personal hygiene, questions about paying rent and bills, transportation needs, and eating and cooking habits. Many interviewees who had good jobs that they enjoyed lost these jobs simply because they lacked skills that had nothing to do with their ability to perform the tasks at work. Some examples include not calling in when sick, taking too long at break-time, punctuality, and socializing too much with co-workers. Many of these problems could have been recognized and prevented with transitional support. By using guidelines mentioned throughout this paper, service providers will be better able to recognize consumers who will need transitional support, which will help increase the number of successful closures and improve the quality of life for those receiving services.

Determining whether clients have these characteristics can be accomplished during the initial interview by having a standard initial interview procedure or form that service providers follow. Questions should be asked conversationally as well as formally. This would involve more time than an initial interview in which these characteristics are not addressed. However, in the long run, time will be saved by being able to recognize services that the person is not ready for, which in turn leads to providing more appropriate services to meet the person's current level of development.

Risk Factors

Each student in this study had at least one risk factor, but usually more than one. Some of the more revealing risk factors of the study group were ethnicity, presence of secondary disabilities, low SES, and a lack of appropriate role models. These were risk factors for which specific corroborating information was found during the course of the study. However, there are some systemic risk factors that play a part in hampering successful closures. Included in these are a lack of qualified interpreters, difficulty in obtaining interpreters in rural areas, discrimination due to deafness, and inadequate funding. There is little that can be done at the counselor's level of influence to completely alleviate the impact of these risk factors, therefore it is important to be aware of them and to provide services designed to offset their effects. Another risk factor that is important to be aware of is substance abuse. Ten percent of the interviewees reported abuse or misuse. Therefore, it is important to always inquire into the possibility of substance misuse or abuse.

Additionally, documentation by service providers of these risk factors and services provided is important. Documentation helps to alleviate the negative impact of these risk factors by providing proof of the need for services to the agency administration. It can assist with convincing administrators to embrace creative and perhaps unorthodox methods of serving those in need of extended services. Some examples of unorthodox methods connected to employment include training co-workers and employers in ways to facilitate LFD employees, cross-train persons in two different vocational areas (e.g., laundry and domestic work), and job shadowing (this is not normally done with LFD). Unorthodox methods regarding counseling, information giving/receiving, and consumer decision-making, include things such as developing visual models out of everyday items, paper and pencil drawings for explaining options, and using string, line drawings, or rulers for time- line information. Finally, documentation can bring a clearer understanding to those who do not experience the day-today frustrations of being limited in what can be done for those seeking services.

There are several possible employment strategies for this heterogeneous group (IRI, 1999). Federal agencies and those entities contracting with federal agencies are required to use noncompetitive recruitment and hiring of applicants who have a disability. Additionally, state, county, and city civil service systems may have similar policies. Often, community and civic organization leaders have an interest in service projects which can be targeted. A final area in which to focus are national chains, such as Marriott, Hardees, UPS, and Federal Express, which have established records of hiring people with disabilities.

The road to service provision is not always easy and well-defined. However, as awareness is raised not only among service providers, but among administrators, families, employers and employees, obstacles that have been prevalent will begin to diminish and perhaps, in the not-so-distant future, become almost eliminated.

Table 1

Social and Emotional Skills

Class                     Number Received    Percentage
                               Class

Communication Skills            24               48
Behavior Management             24               48
Stress Management               13               26
Decision Making Skills          27               54
Self-Esteem                     22               44

n=50

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Kathy Wheeler-Scruggs

Philander Smith College

Dr. Kathy Wheeler-Scruggs, Psychology Dept., Philander Smith College, One Trudie Kibble Reed Drive, Little Rock, AR 72202-3769. Email: [e-mail]