Rehabilitation counselors' knowledge of hearing loss and assistive technology. (Knowledge of Hearing Loss).

The Americans with Disabilities Act of 1990 (ADA) mandates the provision of equal opportunities to people with disabilities in all aspects of life, including employment. One of the most prevalent disabilities in the United States is hearing loss (Cavendish, 1998). Recent statistics indicate that approximately 28 million people in the United States have some degree of hearing loss (National Institute on Deafness and Other Communication Disorders, 1996). Of these 28 million people, 26.8 million (approximately 96%) individuals are hard of hearing (1) and 840,000 (approximately 3%) are late-deafened2. The remaining 280,000 (1%) are prelingually deaf or have lost their hearing before the age of 18 (National Center for Health Statistics, 1994). The high incidence of acquired hearing loss is related in part to noise exposure occurring in many work settings. Noise-induced hearing loss is the second most reported occupational illness or injury (Centers for Disease Control and Prevention, 2001).

Despite the ADA's mandate for equal opportunity and the prevalence of hearing loss, many people who are deaf or hard of hearing still find their opportunities limited. A major obstacle to accommodation is a lack of knowledge about how to create ideal communication settings for people with a hearing loss. As a result, individuals who are hard of hearing or late-deafened find many settings lacking accommodations that would provide them equal access, specifically through assistive technology and the use of strategies that facilitate communication with hearing individuals. When encountered in a place of employment, such barriers may have a negative effect on career opportunities of people with a hearing loss.

Rehabilitation counselors can play a vital role in promoting equal opportunities for people with a hearing loss, including those who are hard of hearing or late-deafened. Research indicates that rehabilitation specifically relating to hearing loss has significant supportive effects (Backenroth & Ahlner, 1997). Much literature on the rehabilitation of people with hearing loss, however, focuses on issues facing deaf people who use sign language, who are members of the Deaf community, and who are disadvantaged vis-a-vis hearing people in their use of English (e.g., Belknap, Korwin & Long, 1995; McCann, 1993; Wyatt & White, 1993). More limited is the literature on issues that are relevant to the rehabilitation needs of people who are hard of hearing and late-deafened.

People who are Hard of Hearing or Late-Deafened

The main differences between people who are hard of hearing or late-deafened and those who are deaf from birth or infancy are their primary form of communication and the extent to which they use their residual hearing. Many people who are prelingually deaf (i.e., profoundly deaf before developing oral language) use sign language for communication. In contrast, people who are hard of hearing or late-deafened are more likely to communicate orally (Laszlo, 1995). With the use of hearing aids, assistive devices, or both, many individuals who are hard of hearing are able to use their residual hearing to develop speech and oral language skills and thus, function quite well in a hearing environment. Similarly, many people who are late-deafened had already developed oral language skills prior to acquiring a hearing loss, and did not experience oral communication difficulties until they lost their hearing. The reliance on oral communication separates people who are hard of hearing and late-deafened culturally from the majority of prelingually deaf people. People who are hard of hearing and late-deafened tend to live in the "hearing" world and maintain personal links to hearing individuals, whereas most prelingually deaf people are members of the Deaf community (Seppa, 1997).

Hearing Loss Accommodation

Many people who are hard of hearing or who lose their hearing later in life have to significantly adjust their careers and professional goals because their hearing loss affects task performance, social participation and opportunities for career advancement (Hetu & Getty, 1993; Rutman, 1989). Many situations they encounter in a typical workplace present difficulties. The most frequently reported obstacles involve communication with more than one person at a time and communication in environments with high levels of background noise, such as during department and staff meetings, in-service training sessions, and work-related social functions (Scherish, 1996).

Advanced technology offers individuals who are hard of hearing and late-deafened a broad range of interventions to accommodate their hearing needs (Levitt & Bakke, 1995). Providing assistive devices to these individuals was found to be a significant factor in successful employment. In a study of working adults who had become hard of hearing or deaf, Glass and Elliot (1993) reported that over a half of their sample maintained successful employment. Those who made successful adaptations to hearing loss attributed their success on the job to the importance of using technology such as fax, electronic mail, teletypewriters (TTYs), relay systems, and assistive listening devices.

The Importance of Rehabilitation Counselors

Rehabilitation counselors can support individuals who are late-deafened and hard of hearing by providing specific information on available accommodations. Research indicates that people who are hard of hearing and late-deafened can benefit from knowledge about: (a) appropriate assistive listening and alerting devices (Gibler, 1995; Glass & Elliott, 1993; Levitt & Bakke, 1995; Moore, 1995; Mowry & Andersen, 1993), (b) accommodations on the job (e.g., receiving an amplified telephone or restructuring duties [Glass, 1990; Glass & Elliot, 1992; Marasovic, 1992; Merker, 1990]), and (c) strategies for communicating with employers and co-workers (Kampfe, 1990; Souza & Hoyer, 1996). In addition, participation in social support groups with other individuals who are deaf and hard of heating facilitated by experienced rehabilitation counselors may encourage effective communication strategies and assertiveness at work (Glass & Elliot, 1993; Hem & Getty, 1993), as well as overall adjustment.

Rehabilitation counselors need to be aware of the concerns facing clients who are hard of hearing and late-deafened in order to offer them effective counseling. Research indicates, however, that rehabilitation counselors and other professionals often lack information about the needs of clients with a heating loss. Lass, Carlin, Woodford, Campanelli-Humphreys, Hushion-Stemple, and Boggs (1986) assessed professionals' knowledge of and exposure to people with a hearing loss. Participants in that study completed a 13-item questionnaire that covered a range of issues regarding hearing loss: prevalence, etiology, testing, prevention, communication skills, hearing aids, and characteristics of individuals with a hearing loss. Among the sample of 303 professionals (classroom teachers, special educators, physicians, and rehabilitation counselors), many participants lacked adequate information about hearing loss. The average percentage of correct responses for all four categories of professionals was 74%, with a range of 61% to 82%. Rehabilitation counselors had the lowest percentage of correct responses of all professionals in the study.

In addition, Lass et al. found that almost half of their respondents had had no exposure to hearing loss in their professional training. They suggested that information about hearing loss be disseminated in educational institutions and in pre- and in-service training sessions. Glass and Elliot (1992) also recommended that rehabilitation counselors be given more information regarding the specific rehabilitation needs of people who are hard of hearing or late-deafened.

In a study of individuals with different types of hearing loss, Glass and Elliott (1993) administered a brief questionnaire to members of Self Help for Hard of Hearing People (SHHH) and Association of Late-Deafened Adults (ALDA) and conducted in-depth interviews with people who had coped successfully with their hearing loss. Interestingly, the participants' average age at onset of hearing loss was in the mid-thirties; that is, they had decades ahead of them of potentially productive work life. The participants' responses indicated that their hearing loss interfered most with the ability to communicate and that difficulties in communication hindered their success at work as well as in personal relationships.

Similarly, Stika's (1997) study of work experiences among adults who are hard of hearing indicated that for most people, hearing loss has a major impact on a person's employment status and career. One factor that limits career opportunities of people with a hearing loss is lack of information about assistive devices appropriate for the workplace. These findings point to the importance of professional assistance in the process of implementing such devices and strategies to ensure successful communication in the workplace (Stika, 1997). Unfortunately, research shows that people who are hard of hearing or late-deafened only rarely use rehabilitation services (Glass & Elliot, 1993). Those who have received vocational rehabilitation services, however, found them helpful in addressing their communication needs and suggesting improved ways of coping.

The research reported in this article had four objectives. The first objective was to identify the level of knowledge that rehabilitation counselors have about specific concerns facing individuals who are hard of hearing and late-deafened. It was hypothesized that rehabilitation counselors' knowledge of concerns facing these individuals would be limited. The second objective was to demonstrate that knowledge of deafness and hearing loss is acquired by professional training. Thus, it was hypothesized that (a) with increased training, rehabilitation counselors would know more about the needs of clients with a hearing loss and how to address them and (b) rehabilitation counselors would know more than professionals not in the field of rehabilitation. Third, the study sought to determine what information graduate training programs in rehabilitation counseling provided about these subjects. It was hypothesized that the curricula of rehabilitation training programs would contain little information to prepare counselors to assist clients with a hearing loss, especially those who are hard of hearing or late-deafened. More specifically, it was hypothesized that the educational institutions that teach their students about clients with a hearing loss would focus on adults who are prelingually deaf and sign language users rather than clients who are hard of hearing or late-deafened. Finally, the study compared the knowledge of rehabilitation counselors surveyed by Lass et al. (1986) to the rehabilitation counselors who participated in the current study to determine whether the knowledge about hearing loss changed in the past 15 years. No specific hypothesis was made about this comparison.

Study I: Survey of Rehabilitation Counselors

This study examined the knowledge that rehabilitation counselors have about people with a hearing loss, particularly people who are late-deafened or hard of hearing.

Method

Procedure

Names were selected randomly from two membership lists of rehabilitation professionals: 100 from the American Deafness and Rehabilitation Association (ADARA) and 200 from the National Rehabilitation Association (NRA). Three attempts were made to elicit participation in the study. First, a questionnaire was mailed to all potential participants. Second, a month later, a reminder card was mailed to those who did not respond. Finally, approximately one more month later, the questionnaire was mailed again to those who did not respond. In addition, a convenience sample of non-rehabilitation professionals, comprising of personal and professional contacts of this study's authors, received the questionnaire.

Participants

Of the 300 potential participants who were randomly selected, 140 responded (response rate of 47%). Half of ADARA members (n = 51, 50%) and 44.5% (n = 89) of NRA members returned the questionnaire. In addition, a convenience sample of professionals who were not in the field of vocational rehabilitation (n = 32) completed the survey, culminating in a total of 172 respondents.

Table 1 presents demographic and professional information collected from the three groups of participants. Additionally, it presents information on participants' experience with hearing loss, either their own or others'.

Comparing ADARA and NRA members. ADARA members were significantly younger than NRA members (Ms = 38.4 and 48.2, respectively), t (29) = 2.47, p < .05, and had practiced rehabilitation counseling for significantly fewer years (M = 6.43) than NRA members (M = 14.18), t (118) = 4.06, p < .001. Although a similar percent of ADARA and NRA members reported having a family member with a hearing loss (54.0% and 45.9%, respectively), more ADARA members reported having friends or acquaintances with a heating loss than NRA members, [chi square] (1, N = 137) = 13.25, p < .001). More ADARA members had also served clients with a hearing loss (n = 42, 84%) compared to NRA members (n = 54, 62%), [chi square] (1, N = 137) = 7.28, p < .01. In addition, significantly more ADARA members had a hearing loss themselves (37.3%) compared to NRA members (5.0%), [chi square] (1, N = 131) = 22.38, p < .001.

Fewer ADARA participants (27.4%) earned a degree in rehabilitation counseling compared to NRA members (69.3%), [chi square] (1, N = 140) = 22.78, p < .01, but more ADARA respondents (21.5%) had a deafness rehabilitation counseling degree compared to NRA members (3.4%), [chi square] (1, N = 140) = 11.75, p < .01. Although there was no significant difference between the percent of ADARA members (n = 17, 48.6%) and NRA members (n = 32, 36.8%) who received in-service training regarding issues related to people who are hard of hearing or late-deafened, ADARA members trained for significantly more hours (M = 1.69) than NRA members (M = .93), t (117) = 2.19, p < .05.

Comparing rehabilitation counselors and non-rehabilitation professionals. The group of non-rehabilitation counselors (NRC) was made up of people who were comparable to rehabilitation counselors (RC) in many respects except for experience in the field of rehabilitation counseling or deafness. The NRC included lawyers, MBAs, social workers, engineers, etc. There were no significant differences in gender or age between the two groups. Although there were some differences in the ethnic/racial composition between the two groups, the vast majority of participants in both groups was White (RC = 95%, NRC = 93%).

Twenty-three rehabilitation counselors (18%) reported some degree of hearing loss whereas none of the NRC respondents had a hearing loss, [chi square] (1, N = 157) = 5.34, p < .05. Overall, a significantly higher percentage of the RC sample (95.0%) knew someone who had a heating loss than the NRC sample did (69.0%), [chi square] (1, N = 169) = 21.83, p < .001. Significantly more of the RC sample (76.6%) had friends with a hearing loss than did NRC participants (33.3%), [chi square] (1, N = 167) = 21.52, p < .001. Interestingly, the percentage of RC participants and NRC participants who had family members with a hearing loss was similar (48.9% and 40.0%, respectively).

Materials

A questionnaire was used to provide a measure of the overall knowledge of rehabilitation counselors. The questionnaire included a previously developed measure that elicited knowledge of issues related to hearing loss (Lass et al., 1986). In addition, questions specific to people who are hard of hearing or late-deafened were added to the measure. The final questionnaire had three sections.

The first section consisted of 23 true/false questions that measured overall knowledge about hearing loss and assistive technology. Of these, 13 questions measured overall knowledge of hearing loss (Lass et al., 1986). The additional 10 questions were designed to assess specific knowledge of issues regarding people who are hard of hearing or late-deafened, 7 of which measured knowledge of assistive technology (for a list of the new questions, see Table 2).

The second section was comprised of six vignettes that were based on actual situations. The vignettes described people who were late-deafened or hard of hearing who experienced problems in school or at work because of their hearing loss (all were based on true situations). Each vignette included several solutions, some of which were applicable to the particular situation and others that were not. The participants were instructed to rank in order of appropriateness the different solutions (i.e., 1 was the best solution, 2 was the second best solution, etc.). The purpose of this section was to assess how participants would actually counsel a client who was hard of hearing or late-deafened. (See appendix for a sample (3)).

Three experts -- rehabilitation counselors experienced in working with hard of hearing and late-deafened consumers -- created the answer key for the six vignettes by collectively ranking the responses. The respondents' answers were then compared to this key. A response that was ranked as "best" or "second best" by a respondent was considered to match the experts' "best" ranking. Similarly, a response that was ranked as "worst" or "second worst" by the respondent was considered to match the experts' "worst" ranking. All other responses, including missing data, were considered not to match the key.

The third and final section of the questionnaire elicited demographic and educational information about the participants.

Results

Tables 3 and 4 summarize scores obtained by ADARA and NRA members (rehabilitation counselors) and non-counseling professionals. Scores obtained in response to true/false questions are presented in Table 3; scores obtained in response to vignettes are presented in Table 4.

Rehabilitation counselors: ADARA and NRA Members Questionnaire: Knowledge of deafness. ADARA members had a significantly higher overall score (M = 19.35) than NRA members (M = 17.68), t (137) = 4.25, p < .001. This was true for all subsets of questions: the 13 questions measuring general knowledge of hearing loss (Lass et al., 1986; [M.sub.ADARA] = 11.92, [M.sub.NRA] = 10.99), t (138) = 3.85, p < .001 and the 10 questions about knowledge of people who are late-deafened and hard of hearing ([M.sub.ADARA] = 7.43, [M.sub.NRA] = 6.63), t (137) = 3.14, p < .01 that included the seven questions about assistive devices ([M.sub.ADARA] = 4.67, [M.sub.NRA] = 4.09), t (137) = 2.77, p < .01.

Paired t-tests compared the difference in participants' percentage score on the 13 questions of Lass et al. (1986), and the 10 questions specific to people who are late-deafened or hard of hearing, including the seven questions specific to assistive technology. Members of ADARA answered correctly a significantly higher percent of the 13 questions measuring knowledge of hearing loss in general (i.e., Lass et al. [1986] questions; M = 91.7%) compared to scores measuring knowledge specific to people who are late-deafened or hard of hearing (M = 74.3%), t (50) = 9.14, p < .001, and compared to the seven questions specific to assistive technology (M = 66.7%), t (50) = 11.35, p < .001. Similarly, NRA members answered correctly a significantly higher percent of the 13 questions measuring knowledge of hearing loss in general (M = 85.0%) compared to scores measuring knowledge specific to people who are late-deafened or hard of hearing (M = 66.4%), t (87) = 11.33, p < .001, and compared to the seven questions specific to assistive technology (M = 58.4%), t (87) = 13.72, p < .001.

Vignettes. A higher percentage of ADARA members than NRA members identified the two "best" choices for all six vignettes, although the difference reached statistical significance only for two vignettes. For Vignette 4, 98.0% of ADARA members but only 88.8% of NRA members responded correctly, [chi square] (1, N = 140) = 3.85, p < .05. For Vignette 5, 100% of ADARA members but only 89.9% of NRA members responded correctly, [chi square] (1, N = 140) = 5.51, p < .05. There was a marginally significant difference between ADARA and NRA members' responses to two other vignettes (Vignette 2, [chi square] [1, N = 140] = 3.65, p < .10; and Vignette 6, [chi square] [1, N = 140] = 3.16, p < .10).

There were no significant differences in the percentage of ADARA and NRA members who correctly selected the two "worst" choices. In most instances (all but one vignette), counselors correctly identified more of the "best" responses than the "worst" responses.

Rehabilitation Counselors and Non-Rehabilitation Counselors

Questionnaire: Knowledge of deafness. Rehabilitation professionals had a significantly higher overall score (M = 18.29) than non-rehabilitation professionals (M = 16.03), t (167) = 4.77, p < .001. This was true for all subsets of questions: the 13 questions measuring overall knowledge of hearing loss (Lass et al., 1986; [M.sub.RC] = 11.32, [M.sub.NRC] = 10.16), t (168) = 3.91, p < .001, and the 10 questions about knowledge of people who are late-deafened and hard of hearing ([M.sub.RC] = 6.92, [M.sub.NRC] = 5.86), t (167) = 3.59, p < .001, including the seven questions about assistive devices ([M.sub.RC] = 4.30, [M.sub.NRC] = 3.43), t (167) = 3.50, p < .001.

Vignettes. Chi-square analyses showed that more rehabilitation professionals than non-rehabilitation professionals were able to identify correct responses to the vignettes. For two vignettes, a significantly higher percentage of counselors correctly identified both the "best" and the "worst" solutions compared to non-counselors (Vignette 2, best: RC = 64.3%, NRC = 40.6%, [chi square] = 6.07, p < .05; worst: RC = 40.0%, NRC = 18.8%, [chi square] = 5.10, p < .05. Vignette 5, best: RC = 93.6%, NRC = 75.0%, [chi square] = 10.08, p < .001; worst: RC = 86.4%, NRC = 71.9%, [chi square] = 4.04, p < .05).

For two other vignettes, counselors obtained higher scores when identifying the "best" solution, but their "worst" solutions did not differ from non-counselors (Vignette 1, best: RC = 62.9%, NRC = 43.8%,[chi square] = 3.94, 12 < .05; Vignette 4, best: RC = 92.1%, NRC = 75.0%, [chi square] = 7.79, 12 < .01). For the remaining two vignettes, counselors more often correctly selected the "worst" solution but were as likely as non-counselors to correctly select the "best" solution (Vignette 3, worst: RC = 75.7%, NRC = 59.5%,[chi square] = 3.50, p < .10; Vignette 6, worst: RC = 65.0%, NRC = 43.8%, [chi square] = 4.94, p < .05.

Comparison with the Sample of Lass et al. (1986)

Chi-square was used to analyze the differences between the percentage of rehabilitation counselors who correctly answered the items measuring general hearing loss in the current study and in the study conducted in 1986 (see Table 2). For 8 of the 13 items, rehabilitation counselors today scored significantly higher than the counselors in 1986 did (Lass et al., 1986). Areas of improvement included cause of hearing loss, testing, hearing aids, prevention, and communication.

Predictors of Knowledge About Hearing Loss and Assistive Devices

To assess factors predicting knowledge about hearing loss and assistive devices, a hierarchical regression analysis was conducted. Several variables that were significantly correlated with the total score on the questionnaire were selected for this analysis: knowledge of deaf or hard of hearing people (r = .30, p < .01), a degree in rehabilitation counseling (r = -.19, p < .05), having clients with a hearing loss (r = .28, p < .01) and the number of in-service training hours received about hard of hearing and late-deafened people (r = .25, p < .01). Organizational affiliation (ADARA, NRA or non-rehabilitation professional) was entered on Step 1 to control for variance attributable to the participant's professional field and specialization. Knowledge of other people who are deaf or hard of hearing, a degree in rehabilitation counseling, having clients with a hearing loss, and number of in-service training hours obtained about serving clients with a hearing loss were entered on Step 2.

Organizational affiliation, entered in Step 1 ([beta] = -.23, p < .01) contributed 30% to the variance in the knowledge scores. In addition to the effect of organizational affiliation, two variables added in Step 2, knowing hard of hearing or deaf people ([beta] = .24, p < .01) and receiving in-service training on serving hard of hearing or late-deafened clients ([beta] =. 17, p = .06), contributed significantly to the prediction of knowledge about hearing loss, increasing the variance explained to a total of 43%. Similar results were obtained for one of the subscales, the 13 items measuring general knowledge about hearing loss (Lass et. al., 1986). Greater knowledge about hearing loss was associated with knowing more people who have a hearing loss ([beta] = .25, p < .01) and the number of in-service training hours on the subject of hearing loss ([beta] = .26, p < .01).

Study II: Survey of Rehabilitation Programs

This survey examined the extent of information rehabilitation counseling students receive about people with a hearing loss and assistive technology in vocational rehabilitation counseling programs in the United States. Curricula used in graduate training programs in vocational rehabilitation counseling were examined for content related to the needs of people with a hearing loss generally, and particularly to the needs of people who are hard of hearing and late-deafened.

Method

Sample

There are 44 graduate general rehabilitation programs and 7 programs that train deafness rehabilitation counselors in the United States. Of these, 27 (61.3%) general rehabilitation counseling programs were randomly selected together with all seven deafness rehabilitation programs to participate in the study. Of the programs contacted, 19 (70.3%) general rehabilitation programs and 6 (85.7%) deaf rehabilitation programs responded with sufficient information to be included in the final sample. The resulting sample represents a considerable proportion (49%) of rehabilitation programs across the country, including universities located in the West (16%), South (40%), Midwest (32%), and the Northeast (12%) of the United States.

Procedure

First requests for information were mailed in November 1998, followed by second requests in March 1999, and third in April 1999. Final requests were made via e-mail to program coordinators who had not responded to the previous mailings. One coordinator provided information in a personal interview format and one was surveyed on the phone.

Program directors were asked to describe the form and extent to which their programs provide information about persons who are hard of hearing and late-deafened and the needs of these clients for assistive listening and alerting devices. In addition, materials related to deafness and hearing loss covered as part of the curricula were requested. All programs were assured full anonymity regarding their responses to the survey. This strategy increases the accuracy of the collected responses by controlling for social desirability effects and by decreasing evaluation anxiety.

Materials

Descriptive information collected from rehabilitation programs was obtained either directly from program administrators or from school Internet pages. The following sources of information were used to identify the extent of training in the rehabilitation of clients with a hearing loss:

1. Course descriptions and syllabi of courses offered through each rehabilitation training program, including required texts, videos, lectures by invited speakers, and field trips.

2. Program descriptions, training objectives, and field placement opportunities provided through each school.

3. The extent to which students in the programs are encouraged to specialize in rehabilitation of deaf people, either through class discussion or through other formats, such as choosing deaf rehabilitation as a topic of an independent study, or written class assignment.

Results

Information About Persons With a Hearing Loss

General rehabilitation programs. Fifteen (78.9%) general rehabilitation counseling programs provided students with information about the needs of clients with a hearing loss. Of these, 14 (73.6%) programs provided this information through courses that were required for the completion of the degree. The majority of required courses addressing hearing loss were courses on medical aspects of disability (N = 10, 52.6%) and courses on psychosocial aspects of disability (N = 11, 57.8%). A few programs provided information about clients with a hearing loss in a required "Introduction to Rehabilitation" course (N = 4, 21%), a "Cross-Cultural Seminar" (N = 1, 5.3%), and a course on assessment (N = 1, 5.3%.)

The typical extent of training focusing on rehabilitation of clients with a hearing loss ranged between 1/2 to 2 class periods in any given course. Other training formats employed a guest lecture, a paper assignment option, and a field trip to a local school for the deaf. The extent of the training varied; yet in all cases the time devoted to rehabilitation with clients with a hearing loss did not exceed 2% of the total amount of training (4). In addition to required coursework, some programs (N = 5, 26.3%) addressed issues related to hearing loss through elective courses covering a diverse range of specific topics in rehabilitation in general and the rehabilitation of persons with a hearing loss in particular. These courses were designed to address the following areas: "Problems and Needs of the Hearing Impaired," "Hearing Science," "Sign Language," "Job Accommodation," "Assistive Technology," "Special Education," and "Rehabilitation with the Aging."

Deaf rehabilitation programs. As anticipated, all deaf rehabilitation programs (N = 6, 100%) required students to attend courses addressing the needs of persons with a hearing loss. The particular structure and extent to which hearing loss issues were addressed, however, differed among the programs. Some programs (N = 3, 50%) provided a deaf rehabilitation specialization option, consisting of approximately 30% of all training activities dedicated to rehabilitation of clients with a hearing loss and 70% of the program of study concentrated on general rehabilitation issues. Other programs (N = 3, 50%) offered a full curriculum of courses tailored to the needs of clients with a hearing loss, in which more general themes and theories in rehabilitation were explicated with reference to clients who have a hearing loss.

Making Distinctions Between Clients With a Hearing Loss: Information about Persons who are Hard of Hearing or Late-Deafened

Deaf rehabilitation programs were more likely than general rehabilitation programs to include information about clients with a hearing loss and to differentiate among clients who are deaf, hard of hearing, and late-deafened (see Table 5).

General rehabilitation programs. The majority of general rehabilitation programs (N = 12, 63.1%) provided students with information about the different needs of clients who represent two segments of the population with a hearing loss: clients who are deaf and those who are hard of hearing. Among those programs that did not make distinctions between the different segments of this population, information was provided only about clients who are deaf.

A small portion of the general programs (N = 3, 15.7%) addressed the distinct issues facing all three segments of the population of clients with a hearing loss: those who are deaf, hard of hearing, and late-deafened. The particular formats through which these distinctions were made during the program of study, however, could not be determined from the materials received. In all three cases where program coordinators claimed to have made those distinctions, there were no course materials available to support these claims. Therefore, the likely extent of training that focused separately on the needs of deaf, hard of hearing, and late-deafened clients was minimal in general rehabilitation programs. The issues that arise in rehabilitation of these clients were addressed minimally at best, and likely not at all.

Deaf rehabilitation programs. Most deaf rehabilitation programs (N = 5, 83.3%) distinguished between all three segments of the deaf population in their curricula. The emphasis on the inclusion of information about clients who are hard of hearing and late-deafened varied by program. Only one program (16.6%) explicitly acknowledged training of rehabilitation counselors to serve deaf, hard of hearing, and late-deafened clients by noting distinctions in the title of the program. All other deaf rehabilitation pro grams (N = 5, 83.3%) were named "Deafness Rehabilitation Counseling."

Similarly, on the level of class instruction, the emphasis was on the distinction between clients who are deaf and those who are hard of hearing. Issues facing individuals who are late-deafened were the least likely to be addressed even in deaf rehabilitation counseling training. Typically, materials addressing the needs of late-deafened clients were provided in the form of assigned readings. However, readings dealing with late-onset deafness were less frequently assigned than those addressing clients who are deaf or hard of hearing. Late-deafened clients were also less likely to be made a specific topic of a class lecture, again indicating that the needs of these clients were covered only marginally and informally.

Assistive Technology Training

Deaf rehabilitation programs offered more information regarding assistive technology than general rehabilitation programs did. Table 6 lists the number and percentage of rehabilitation counseling programs offering information about assistive devices.

General rehabilitation programs. Information regarding the availability and use of assistive listening devices was rarely offered as part of the general rehabilitation curricula. Only three programs (15.7%) offered courses that explicitly dealt with assistive devices for clients with a hearing loss, and none of these courses was part of the required program of study. It is likely, however, that assistive technology was discussed as part of other (non-required) courses that three programs (15.7%) offered. These courses addressed the needs of clients with a hearing loss, such as courses in "Aural Rehabilitation," "Hearing Science," and "Job Accommodation."

Deaf rehabilitation programs. All deaf rehabilitation programs offered courses that covered assistive technology; however, only one program (16.6%) made a course titled "Assistive Technology" a required part of students' training. Overall, the extent to which assistive technology was covered in required and non-required courses was difficult to determine. Typically, courses in job accommodation, independent living and community resources, and services for people with a hearing loss included some coverage of assistive devices, but it is unclear to what degree the details of when it is appropriate to use what device were discussed. Only one program (16.6%) provided a summary of assistive devices that students were required to know of as part of program objectives.

Comparison of Training Offered by Rehabilitation Programs in 1999 and Training Received by Rehabilitation Counselors Between 1966-1990.

Table 6 summarizes information obtained from general and deaf rehabilitation programs today and information reported by rehabilitation counselors about their training in the past. Counselors surveyed in Study I earned degrees in rehabilitation counseling between 1966 and 1999; 48 of them (61.3%) received their degree up to 1990. Of these, 42 (87%) received a general rehabilitation counseling degree and 6 (13%) obtained a degree in deaf rehabilitation counseling. Counselors provided information about the extent to which their training during those years addressed serving clients with a hearing loss. This enabled a comparison of training offered in the past and training offered by rehabilitation programs today.

The comparison of training offered through rehabilitation counseling curricula today (1999) and training received by counselors in the past (1966-1990) shows an overall increase in information offered to rehabilitation counseling students about persons who are hard of hearing and late-deafened. Whereas two thirds of counselors (67%) with degrees in deafness rehabilitation indicated learning about hard of hearing and late-deafened persons during their training (obtained in 1966-1990), all deaf rehabilitation programs offer this information today (1999). Similarly, the percentage of general rehabilitation programs offering information about hard of hearing and late-deafened persons rose from 41%, as reported by counselors receiving their training in the past, to 63% as found in the programs' curricula today.

Changes were also noted for the format in which the schools impart information about clients with a hearing loss. Whereas in the past this information was typically covered during lectures on medical aspects of disability (59%), today, information about clients with a hearing loss is increasingly taught also from a psychosocial perspective (18% in 1966-1990; 58% in 1999).

Discussion

The present studies assessed what rehabilitation counselors know about people who are hard of hearing and late-deafened and what information is offered about these consumers by graduate rehabilitation training programs. The results of Study I showed that, not surprisingly, rehabilitation counselors who specialize in deafness know more about hearing loss in general and about issues facing hard of hearing and late-deafened people and about assistive devices in particular compared to general rehabilitation counselors. This was the case even though general rehabilitation counselors had been in the field of rehabilitation counseling longer compared to deafness rehabilitation counselors. In addition, deafness rehabilitation counselors were better able to identify the best ways to counsel clients who were hard of hearing or late-deafened compared to general rehabilitation counselors.

One possible reason that rehabilitation counselors who specialize in deafness demonstrate more knowledge about hearing loss and related issues than general rehabilitation counselors is that more of them had earned a degree in deafness rehabilitation counseling. This would suggest that general rehabilitation training programs do not sufficiently cover deafness-related issues, including issues that affect specifically people who are hard of hearing or late-deafened. Indeed, results of Study II demonstrate that general rehabilitation counseling programs offer much less information on consumers who are deaf and hard of hearing compared to deafness rehabilitation programs. In fact, information covering deaf and hard of hearing consumers in required courses covered only about 2% of the curricula of general rehabilitation programs. This is quite alarming, given that hearing loss is one of the most prevalent disabilities in the United States, affecting about 10% of the population. Moreover, given that most people with hearing loss are not members of the signing deaf community, they are more likely to use the services of general rehabilitation counselors than those of deafness specialists. The failure of general rehabilitation counseling programs to address the needs of this population needs to be rectified.

In-service training is another important factor in increasing counselors' knowledge about clients with a hearing loss. Deafness rehabilitation counselors received more hours of training on issues facing hard of hearing and late deafened clients than general rehabilitation counselors. Number of hours, in turn, contributed significantly to counselors' knowledge above and beyond their organizational affiliation and professional specialization, indicating that more training in this area contributes to greater knowledge.

A third explanation for the greater knowledge of deafness rehabilitation counselors about clients with a hearing loss compared to general rehabilitation counselors is the experience deafness rehabilitation counselors obtained by serving a greater number of clients who are hard of hearing or late-deafened. Results show that having more clients, family members, and friends who have a hearing loss, significantly contributed to counselors' general knowledge of hearing loss concerns of hard of hearing and late-deafened clients and of assistive technology.

Over half of all the rehabilitation counselors in our study reported that they had clients who were hard of hearing or late-deafened who were seeking ways to manage their hearing loss. Based on their answers to the vignettes presented to them, however, general rehabilitation counselors were less likely to know how to counsel such clients than deafness rehabilitation counselors: they either responded incorrectly to the vignettes or did not respond at all. Although deaf clients may seek rehabilitation counselors who are fluent in sign language and are familiar with the Deaf community, hard of hearing and late-deafened clients who identify with the hearing world are more likely to seek a general rehabilitation counselor. It is very important, then, for general rehabilitation counselors to become familiar with issues facing these clients.

As expected, compared to participants who were not counselors (5), results of Study I show that counselors-both generalists and deafness specialists-were better able to identify the correct and incorrect ways to counsel a client who was hard of hearing or late-deafened and were more informed of issues of hearing loss in general and of issues facing hard of hearing and late-deafened people and assistive devices in particular. The comparison of the rehabilitation counselors and non-counselors suggests that knowledge about hearing loss is not common, everyday knowledge. It is likely to be specific to the graduate programs in which the participants received their education and areas in which the participants received in-service training. This finding further supports the importance of providing all counselors with adequate preparation to counsel hard of hearing and late-deafened individuals.

While the results of this study show that many rehabilitation counselors are unprepared to serve hard of hearing and late-deafened individuals in obtaining accommodations necessary for maintaining their careers, they may be more prepared to serve clients with a hearing loss today than counselors in the past. In 1986, Lass and his colleagues surveyed various professionals about their knowledge of issues related to hearing loss. They found that rehabilitation counselors had only minimal knowledge regarding causes of hearing loss, the relationship between aging and hearing loss and the limitations of hearing aids and speechreading (Lass et al., 1986). In comparison, our study found a definite improvement in the state of knowledge of rehabilitation counselors regarding these fundamental facts about hearing loss. Similarly, a comparison between training received by rehabilitation counselors during their graduate study between 1966 and 1990 and training offered by rehabilitation programs today (1999) showed an increase in information offered about the needs of clients with a hearing loss, including clients who are hard of hearing and late-deafened. The increased awareness of and interest in providing adequate training about counseling clients with a hearing loss was also demonstrated by many programs that are now developing initiatives to include information on hard of hearing and late-deafened people in their curricula.

Vocational rehabilitation counselors can serve as a bridge between consumers with hearing loss and employers. They can educate both about the rights of people with disabilities under the ADA and other local laws, recommend appropriate assistive devices, facilitate communication, and support consumers in their efforts to advocate for themselves. In order to fulfill these multiple roles and to better serve clients with all types of hearing loss, vocational rehabilitation counselors need to become knowledgeable about deaf, hard of hearing and late-deafened people, and about how assistive technology can help these workers on the job. There are two primary means to this increased knowledge. First, vocational rehabilitation programs need to include information about these consumers so that future counselors would know how to counsel them. Second, counselors who are already employed need to receive in-service training. In fact, in a previous study, many rehabilitation counselors stated a need for such training to help them serve clients who do not fit in either the deaf or the hearing cultures (Glass & Elliot, 1992). As many organizations around the country offer such training, vocational rehabilitation counselors should be encouraged by supervisors to attend them. With this increased knowledge, counselors will be more able to facilitate workplace accommodation of individuals with hearing loss.

Appendix

Sample Vignette

Tina is a 43-year-old woman who has a severe to profound hearing loss in one ear and a profound loss in the other. She wears behind-the-ear hearing aids and receives good benefit from them. She also relies on speechreading cues and requires clear, slowed speech with no background noise for effective communication. For many years prior to the time her hearing loss was diagnosed at age 30 and for some years after, Tina worked as an actress and director. As her loss progressed it became increasingly difficult for her to pick up cues from other actors and to direct people in a complex scene with lighting designers, set crew, and sound technicians, all vying for her attention, often unseen. She decided to leave acting and got a job as an acting teacher. Here too, she is having difficulty. She cannot always hear her students' questions or know if they are saying their lines correctly. Tina is too embarrassed to ask them to repeat themselves. Tina comes to you for rehabilitation counseling. What do you recommend?

-- Tina should install an FM system in the classroom or an infrared system for the stage.

-- Tina should consider an alternative employment more suited to her hearing loss.

-- She should investigate assistive technology, such as CART.

-- Tina should receive vocational counseling.

-- She should receive audiotherapy and attend a speechreading class.

-- Tina could join a social support group for other late-deafened adults.

-- Tina should investigate the possibility of receiving a cochlear implant.

Table 1.

Demographic Information, Experience with Hearing Loss, and Professional
Background of Participants in Study I.

                                    ADARA Members       NRA Members

Mean age                                 38.4              48.2
Gender: Male                          18 (35.3%)        31 (34.8%)
        Female                        33 (64.7%)        57 (64.0%)
Has a hearing loss (HL)               19 (37%)           4 (5%)
Has a family member with HL           27 (54%)          40 (45.9%)
Has friends with HL                   47 (94%)          58 (66.6%)
Has clients with HL                   42 (84%)          54 (62%)
Employment setting:
  Rehabilitation                      18 (35.2%)        41 (46%)
  Education                           12 (23.5%)        10 (11.2%)
  Mental Health                        8 (15.6%)         6 (6.7%)
  Other                               13 (25.4%)        32 (35.9%)
Degree in rehab. counseling           14 (27.4%)        61 (69.3%)
Specialized in deafness rehab.        11 (21.5%)         3 (3.4%)
Mean years practiced rehab.              6.43              14.1
Mean hours of in-service                 1.69                .93
training in HOH/LD issues

                                  Non-Rehabilitation
                                      Counselors

Mean age                                 41.4
Gender: Male                           6 (18.8%)
        Female                        24 (75%)
Has a hearing loss (HL)                0 (0%)
Has a family member with HL           12 (40%)
Has friends with HL                   10 (33.3%)
Has clients with HL                    3 (10%)
Employment setting:
  Rehabilitation
  Education
  Mental Health
  Other
Degree in rehab. counseling
Specialized in deafness rehab.
Mean years practiced rehab.
Mean hours of in-service
training in HOH/LD issues
Table 2.

Comparison of Professionals' Knowledge of Hearing Loss in 1986 and 1999

Item                                                            1986
                                                              % correct

1. A hearing impaired individual may have problems with
  speech sounds (T). ([dagger])                                 97.0
2. A pregnant woman who gets German measles may give birth
  to a baby with a hearing loss (T). ([dagger])                 97.0
3. We all lose some hearing as we get older
  (T). ([dagger])                                               65.2
4. The hard of hearing person finds vowels (e.g., ah, ee,
  oh) easier to hear than consonants (e.g., s, sh, f)
  (T). ([dagger])                                               53.0
5. More females than males have hearing loss
  (F). ([dagger])                                               39.4
6. Hearing aids usually cost much more than eyeglasses
  (T). ([dagger])                                               93.9
7. In lipreading, we learn to "see each sound" and can
  understand complicated passages even at a great
  distance (F). ([dagger])                                      22.7
8. Exposure to loud noises can cause a person's ears to
  ring (T). ([dagger])                                          12.1
9. A drug by itself cannot cause permanent heating loss
  (F). ([dagger])                                                6.1
10. Infants cannot have their hearing tested
  (F). ([dagger])                                                4.5
11. A hearing aid brings hearing back to normal just as
  eyeglasses bring vision back to normal (F). ([dagger])        68.2
12. Ear protectors such as those used in steel mills or
  factories do not help prevent hearing loss
  (F). ([dagger])                                                4.5
13. In general, profoundly hard of hearing people are less
  intelligent than normal hearing persons (F). ([dagger])       98.5
14. Most hard of hearing people know or can easily learn
  sign language (F).                                            --
15. Hard of hearing people can understand conversational
  speech in a noisy place more easily when their
  conversation partner is nearer rather than farther
  away (T).                                                     --
16. A telephone that is "hearing aid compatible" can be
  used with all types of hearing aids (T).                      --
17. To be considered "hearing aid compatible", a telephone
  must include a volume control (F).                            --
18. Getting a special "FM hearing aid" could be considered
  a "reasonable accommodation" under the ADA (T).               --
19. It is easier for the average hard of hearing person to
  communicate on the telephone with a TTY than with an
  amplified telephone (F).                                      --
20. An "Infra-Red" listening device, rather than an FM
  listening system, would be particularly suitable in
  courtrooms (T).                                               --
21. Because they have a hearing loss, hard of hearing
  people understand speech better than normally hearing
  people in a noisy place (F).                                  --
22. A "conference microphone" is designed to help hard of
  hearing people understand speech in large venues (F).         --
23. Most late-deafened people (with no remaining hearing)
  can communicate on a telephone using either a
  conventional TTY or VCO (voice carry over) (T).               --

Item                                                            1999
                                                              % correct

1. A hearing impaired individual may have problems with
  speech sounds (T). ([dagger])                                 95.5
2. A pregnant woman who gets German measles may give birth
  to a baby with a hearing loss (T). ([dagger])                 96.9
3. We all lose some hearing as we get older
  (T). ([dagger])                                               75.4
4. The hard of hearing person finds vowels (e.g., ah, ee,
  oh) easier to hear than consonants (e.g., s, sh, f)
  (T). ([dagger])                                               46.0
5. More females than males have hearing loss
  (F). ([dagger])                                               78.5 **
6. Hearing aids usually cost much more than eyeglasses
  (T). ([dagger])                                               77.3 *
7. In lipreading, we learn to "see each sound" and can
  understand complicated passages even at a great
  distance (F). ([dagger])                                      78.8 **
8. Exposure to loud noises can cause a person's ears to
  ring (T). ([dagger])                                          95.5 **
9. A drug by itself cannot cause permanent heating loss
  (F). ([dagger])                                               84.6 **
10. Infants cannot have their hearing tested
  (F). ([dagger])                                               95.5 **
11. A hearing aid brings hearing back to normal just as
  eyeglasses bring vision back to normal (F). ([dagger])        92.4 **
12. Ear protectors such as those used in steel mills or
  factories do not help prevent hearing loss
  (F). ([dagger])                                               92.4 **
13. In general, profoundly hard of hearing people are less
  intelligent than normal hearing persons (F). ([dagger])      100.0
14. Most hard of hearing people know or can easily learn
  sign language (F).                                            93.9
15. Hard of hearing people can understand conversational
  speech in a noisy place more easily when their
  conversation partner is nearer rather than farther
  away (T).                                                     69.7
16. A telephone that is "hearing aid compatible" can be
  used with all types of hearing aids (T).                      77.3
17. To be considered "hearing aid compatible", a telephone
  must include a volume control (F).                            15.4
18. Getting a special "FM hearing aid" could be considered
  a "reasonable accommodation" under the ADA (T).               82.8
19. It is easier for the average hard of hearing person to
  communicate on the telephone with a TTY than with an
  amplified telephone (F).                                      69.2
20. An "Infra-Red" listening device, rather than an FM
  listening system, would be particularly suitable in
  courtrooms (T).                                               54.1
21. Because they have a hearing loss, hard of hearing
  people understand speech better than normally hearing
  people in a noisy place (F).                                  93.9
22. A "conference microphone" is designed to help hard of
  hearing people understand speech in large venues (F).         54.8
23. Most late-deafened people (with no remaining hearing)
  can communicate on a telephone using either a
  conventional TTY or VCO (voice carry over) (T).               79.7

Note. * p < .05, ** p < .001

([dagger]) Lass et al. (1986)
Table 3

Participants' Knowledge about Hearing loss, People who are Hard of
Hearing or Late-Deafened, and Assistive Technology: True/False
Questions

                              ADARA             NRA

                                M                M               t
                               (SD)             (SD)            (N)

Overall score (a)             19.35            17.68           4.25 ***
                              (2.00)           (2.35)          (137)

Knowledge of hearing          11.92            10.99           3.85 **
  loss                        (1.26)           (1.44)          (138)

Knowledge of HOH               7.43             6.63           3.14 **
  and LD                      (1.25)           (1.53)          (137)

Knowledge of assistive         4.67             4.09           2.77 **
  technology                  (1.01)           (1.26)          (137)

                                                  Non-
                          Rehabilitation     Rehabilitation
                            Counselors         Counselors

                                M                  M             t
                               (SD)               (SD)          (N)

Overall score (a)              18.2              16.03         4.77 ***
                              (2.36)             (2.29)        (167)

Knowledge of hearing          11.32              10.16         3.91 ***
  loss                        (1.44)             (1.59)        (168)

Knowledge of HOH               6.92               5.86         3.59 ***
  and LD                      (1.48)             (1.38)        (167)

Knowledge of assistive         4.30               3.43         3.50 **
  technology                  (1.21)             (1.33)        (167)

Note. ** p < .01, *** p < .001

(a) A higher score indicates greater knowledge
Table 4

Vignette results

                        ADARA            NRA         [chi square]
                      % correct       % correct      (2, N = 140)

Vignette 1
  best solution         70.6            58.4            2.05
Vignette 1
  worst solution        51.0            47.2            1.86
Vignette 2
  best solution         74.5            58.4            3.65 ([dagger])
Vignette 2
  worst solution        45.1            37.1             .86
Vignette 3
  best solution         74.5            71.9             .11
Vignette 3
  worst solution        82.4            71.9            1.92
Vignette 4
  best solution         98.0            88.8            3.85 *
Vignette 4
  worst solution        72.5            73.0             .00
Vignette 5
  best solution        100.0            89.9            5.51 *
Vignette 5
  worst solution        90.2            84.3             .97
Vignette 6
  best solution         76.5            61.8            3.16 ([dagger])
Vignette 6
  worst solution        72.5            60.7            2.01

                     Counselors      Non-Counselors   [chi square]
                     % correct       % correct        (2, N = 140)

Vignette 1
  best solution         62.9              43.8          3.94 *
Vignette 1
  worst solution        48.6              53.1           .21
Vignette 2
  best solution         64.3              40.6          6.07 *
Vignette 2
  worst solution        40.0              18.8          5.10 *
Vignette 3
  best solution         72.9              71.9           .01
Vignette 3
  worst solution        75.7              59.4          3.50 ([dagger])
Vignette 4
  best solution         92.1              75.0          7.79 **
Vignette 4
  worst solution        72.9              65.6           .66
Vignette 5
  best solution         93.6              75.0         10.08 ***
Vignette 5
  worst solution        86.4              71.9          4.04 *
Vignette 6
  best solution         67.1              62.5           .25
Vignette 6
  worst solution        65.0              43.8          4.94 *

Note. ([dagger]) p < .10, * p < .05, ** p < .01, *** p < .001
Table 5

Inclusion of Information Addressing Rehabilitation of Persons With
a Hearing Loss in General and Deaf Rehabilitation Programs

                                     General           Deaf
                                  Rehabilitation    Rehabilitation
                                     Programs          Programs

Required courses                     15 (78.9%)        6 (100%)

Elective courses                      6 (31.5%)        6 (100%)

Distinctions made between
clients who are deaf and hard
of hearing                           12 (63.1%)        6 (100%)

Distinctions made between
clients who are deaf, hard of
hearing and late-deafened             3 (15.7%)        5 (83.3%)
Table 6

Information Offered Through Rehabilitation Training Programs Today
(1999) and Information Received by Rehabilitation Counselors in the
Past (1966-1990).

                                        Training offered (1999)

                                        General             Deaf
                                    Rehabilitation     Rehabilitation
                                       Programs           Programs

Information about persons             12 (63.1%)          6 (100%)
who are hard of hearing or
late-deafened

Information about                      3 (15.7%)          6 (100 %)
assistive devices (a)

Information offered through (b):

  Medical Aspects of                  10 (52.6%)
  Disability

  Psychosocial Aspects of             11 (57.8%)
  Disability

  Rehabilitation                       3 (26.3%)

  American Sign Language               5 (26.3%)

                                      Training received (1966-1990)

                                    Counselors with    Counselors with
                                    General Rehab.       Deaf Rehab.
                                        Degrees            Degrees

Information about persons             17 (41.5%)          4 (66.6%)
who are hard of hearing or
late-deafened

Information about
assistive devices (a)

Information offered through (b):

  Medical Aspects of                  10 (58.8%)
  Disability

  Psychosocial Aspects of              3 (17.6%)
  Disability

  Rehabilitation                       4 (23.5%)

  American Sign Language               1 (5.8%)

(a) The assessment of counselors' training did not specifically address
training obtained in the knowledge of assistive devices.

(b) The course structure of deaf rehabilitation programs varies;
therefore, course titles offered through deaf rehabilitation programs
were not included in this comparison.

This research was supported by grant #RH133E30015 from the U.S. Department of Education, NIDRR. We gratefully acknowledge assistance from three vocational rehabilitation experts: Florence Rosen, Kathleen Craft, and Dennis Brady. We also thank Mark Ross, Ph.D. for writing the questions on hard of hearing and late-deafened people and on assistive technology.

Notes

(1) People who are hard of hearing have some degree of hearing loss, ranging by decibel (loudness) from mild, moderate, moderately severe, to severe (pure tone average [PTA] between 26 - 90 decibels). Hearing loss in hard of hearing people is either congenital or acquired later in life, and could be in one (unilateral) or both (bilateral) ears.

(2) People who are late-deafened are individuals who became profoundly deaf after having had hearing for a number of years (typically into adulthood) and having developed speech and oral language. These individuals' hearing loss is greater than 90 decibels (i.e., profound), and the loss may occur suddenly or progressively.

(3) All vignettes are available from the first author.

(4) Typically, 48 credit hours (semester hours) of coursework have to be completed before graduation. By assessing the average number of teaching sessions per course (N = 12) and the average number of credits given per course (N = 3), the percentage of time spent on issues in rehabilitation of people with a hearing loss was determined.

(5) Non-counselors in our study did not have other specialized training to work with people who are deaf, such as teachers.

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Yael Bat-Chava, Ph.D., Director of Research, League for the Hard of Hearing, 71 West 23rd Street, 18th floor, New York, NY 10010. Email: [e-mail]