Utah Deaf Videoconferencing Model: providing vocational services via technology.

Rural areas often face limited services when working with clients who are Deaf and hard of hearing. Some of these limitations may include a lack of interpreters, lack of social resources, and a lack of cultural, language, and legal understanding on the part of the service provider. These limitations are addressed and possible answers are explored through the use of the Utah Deaf Videoconferencing Model.

Through the use of modern videoconferencing technology, Utah has begun to find some answers that may prove helpful to the client, practioner, educator, rehabilitation counselor, administrator, and policy maker, when approaching and dealing with clients who are Deaf. The importance of using technology in this arena is captured in this statement from The U.S. Department of Special Education and Rehabilitative Services, "For people without disabilities, technology makes things convenient, whereas for people with disabilities, it makes things possible" (Heumann, 2000).

Literature Review

There has been much written about the use of technology to enhance services to clients in the general or "hearing" population. Professionals in business, education, vocational rehabilitation, medicine, government, defense, and social work to name a few have explored and used technology to serve remote or distance needs (e.g., Augustine, et. al. 1998; Cain, et. al., 200l; Frase-Blunt, 1998; Lee, et. al. 2000; Patterson, 2000). Use of technology in these environments may range from simple e-mail exchanges, internet support groups in rehabilitation, and desk top camera interactions to more complicated uses such as the space program sending and receiving messages and images outside of our earth's atmosphere (e.g., see Patterson, 2000; South Carolina Department of Mental Health, 2002).

Some of the uses of distance technology that the Utah Model takes advantage of include: tele health, tele medicine, and tele education. Tele medicine is described as "the use of electronic communications and information technology or support clinical care at a distance" (Tellda, 2002). Tele health is, "the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, education and information across distance (Tellda, 2002). Mental health counseling falls under the tele health umbrella of care (Lamarche, 2002). Petracchi defines defines distance education as "all types of formal instruction conducted when teachers and students are located a geographic distance from one another" (2000).

Studies of technology being used by the Deaf population seem to have followed the patterns of the general or "hearing" population (e.g., see, Harkins, 2002; South Carolina Department of Mental Health, 2002). The Deaf population has used some unique applications in technology that are not used by the hearing population. These include technology such as video relay phone service (VRS), a pilot program in Minnesota using video remote interpreters to facilitate State Department of Workforce Services interactions with Deaf clients, and distance education including specialized online instruction for students who are Deaf (e.g., Harkins, 2002; Latz, et. al., 2002; Mallory & Rizzo, 2002, Rabelo & Carnahan, 2002).

Another unique application of videoconferencing technology in the field of deafness is in South Carolina. Deaf telepsychiatry has been in existence since approximately 1994 in South Carolina. The program was innovated as the one sign language proficient psychiatrist in the state became confined to her home due to a pregnancy. She was unable to continue to drive long miles across the rural parts of the state to provide psychiatry services to the identified 300 clients who are Deaf and mentally ill. The state established a videoconferencing network from the psychiatrist's home to several sites in the state and she continued her practice from her home. The application has been so successful in South Carolina that the psychiatrist "now reports seeing three times the previous number of clients in only sixty percent of the time." Financial and time savings have accrued "due to lack of staff drive time and related travel costs" (Telehealth News, 1998).

In all of the applications described, sign language may complicate the technology needs required. Gallaudet's Technology Access Program (TAP), seeks to "research technologies and services that eliminate communication barriers" for individuals who are Deaf and hard of hearing. TAP research has found that the appearance of the video images varies from technology to technology. "Some technologies provide pictures that look like a mosaic of tiles; others give a generally grainy appearance, and there are other variations." The quality of service needed to facilitate sign language interactions in video applications is at "30 frames (still pictures) per second. At 30 frames per second (fps), the video is sometimes referred to as full-motion video. Sign languages and lip movements look natural with full-motion video (except that they are two-dimensional instead of three dimensional). At lower frame rates, especially below 15 fps, signed video appears jerky. Below 15 fps, fingerspelling can become distorted, especially if it is done at normal rates." It is suggested that at rates below 30fps, "smooth conversations may be disrupted, and communication may become too difficult to be comfortable" (Harkins, J. 2002). This has implications in rehabilitation and education settings because if the sign language communication is not clear the individuals involved in the interaction cannot understand each other.

Clarity issues researched by Gallaudet's Technology Access Program become vital when developing a video or tele services model to serve the Deaf population. If the technology works for a hearing population, it may or may not work for the Deaf population, based solely on the clarity of sign language that is able to be achieved in videoconferencing environments. Clarity of sign language communication is a fundamental issue when designing a Deaf videoconferencing model.

The Utah Deaf Videoconferencing Model was developed by the Western Region Outreach Center and Consortia (WROCC) Outreach Site at the Robert G. Sanderson Community Center of the Deaf and Hard of Hearing. The model accommodates for sign clarity issues, such as frames per second required for a clear picture and communication in American Sign Language. The model combines the literature and models from the fields of 1) tele medicine 2) tele health and 3) tele education. The Utah model combines these theories and uses videoconferencing technology to create a spectrum of service provision. The model works specifically with the overall goals of the Utah State Office of Rehabilitation, "offering citizens with disabilities opportunities for meaningful employment and increased independence" (Annual Report, 2001).

The rural areas in the State of Utah expressed their primary need as wanting similar access in Deaf and hard of hearing services that urban areas receive. Videoconferencing can help to provide for some of those needs and create a bridge for the rural and urban areas to connect and communicate.

Method

The model targets building community alliances in the post-secondary environment through service and practice. Community partners were approached and partnerships were established Community partners include vocational rehabilitation partners at four sites in Utah. Additionally, there is a partnership with Utah Education Network sites at 10 postsecondary locations throughout the state. There are also partnerships with public and private interpreter service and mentor providers. Two federal grant partners include an educational partnership with federal grant: "Do-It!" interpreting program in Colorado and the federal WROCC Grant (Western Region Outreach Center and Consortia) Outreach Site at the Robert G. Sanderson Community Center of the Deal' and Hard of Hearing. Other partnerships are also under consideration.

The equipment identified and used for the model are 1) dedicated tl lines, 2) polycom fx unit at each site, 3) a television, and 4) a DVD+VCR machine. Each of the test sites is equipped with this noted mechanical protocol.

A survey was intermittently given to each of the sites in year one of the pilot project to evaluate issues including clarity of communication, uses of the model, and overall satisfaction with the model and services. Respondents were Deaf, hard of hearing, and hearing. Respondents included professionals, students, clients, and administrators. The sample was drawn in a purposive manner based on usage. The survey was given during three 10 day periods of usage throughout the first year. Fifty-three surveys were given and all 53 of the surveys were returned completed and useable.

Results

Some of the uses of this equipment and technology were remote planning meetings for service provision in rural areas of the state. These planning meetings included remote sites and individuals who are Deaf, hard of hearing, and hearing each communicating using the technology. There are several barriers to overcome in distance meetings including individuals who are Deaf and hard of hearing. There are diverse communication needs involved in these meetings, such as American Sign Language users and those individuals who only use speech as their communication mode. There is also up to an eight hour geographic separation when connecting with some of the rural areas of the state. A meeting of this type in the past has been impossible due to geographic distance and the costs inherent in having all of these people brought to one location. Videoconferencing technology allows these meetings and outreach to rural areas to become a reality.

Some sample comments from videoconferencing participants include, "This was so much better than using the phone. Was able to involve so many people in the planning process. People involved included hearing, Deaf, and hard of hearing. Planning would have been impossible if this were done over a phone or regular tty." However, there still appeared to be some technical difficulties in these meetings. Comments such as, "Is it possible that the large amount of data being sent (there were 11 people in the outreach site room) causes more specks and blurred images? However, the signing was still easy to understand."

In spite of the sporadic technical difficulties, most comments were very positive and concluded that this service model should continue to be developed. These comments included the following: "I have to admit that I was somewhat skeptical about the use of this equipment. After using it, I think it is terrific!" "I would love to see this equipment set up everywhere and not just a few select locations. This would be wonderful for establishing distance education."

In combination with the outreach meetings, further needs have been served. For example, remote interpreting has been able to occur for vocational rehabilitation evaluations. These evaluations are assessments that guide placement for education and or employment through the vocational rehabilitation program. Using the technology, remote interpreting is provided. This service is provided without the traditional transportation costs and a three to four day commitment of interpreter services that is sometimes required for an evaluation of this type. Through remote technology, interpreters sit at one site and facilitate the initial instructions for these evaluations and then are able to serve other clients and needs while the evaluations are taking place. This application has saved time, money, and travel.

Another unique application in the spectrum of service is mental health counseling. The State of Utah Office of Vocational Rehabilitation employs mental health counselors who are fluent in American Sign Language. In the past, services have been limited by geography to serving only a limited amount of clients in the state. Traditionally that service has been limited to those who can drive to the counselor. Often the gas money involved in getting to the counselor or the costs for public transportation were impossible barriers in receiving needed counseling. Now through technology, the counselor can provide mental health counseling to clients to help them increase independence and employability (a goal of rehabilitation).

The Utah State Office of Rehabilitation also uses this technology to facilitate their monthly meetings of RCD's (Rehabilitation Counselors for the Deaf'). These meetings include Deaf and hearing counselors who work with the Deaf and hard of hearing rehabilitation population. Geographic limitations at times have made attending these meetings impossible (particularly when there is inclement weather). A traditional phone conference using a speaker phone has been used at times to overcome this obstacle, but was not totally effective. Now, using technology, what was once a three day trip, is now a several hour meeting. Instead of returning to piled up caseloads and paper work that have been "neglected" for three days, the RCD counselor is able to achieve more with the same amount of time. Less stress and fatigue in travel and "catch up" are additional outcomes attributed to the use of this technology. Safety issues of not having to travel six hours on icy winter roads in rural areas is an additional benefit. Another use of the technology is that Vocational Rehabilitation Counselor's who are Deaf are now able to attend staff meetings with the hearing Vocational Rehabilitation staff via remote interpreting.

Finally an application of Sign Language Interpreter Mentoring is occurring because of the model. Using trained Deaf individuals who are language mentors in combination with highly trained hearing interpreter mentors, the service of interpreter mentoring is occurring in rural areas of the state. The mentees (individuals receiving the training) have traditionally not been able to receive this training due to geographic limitations. This service is vital as these mentees are able to increase their sign language skills. This enables them to provide appropriate interpreter accommodations under the ADA (Americans with Disabilities Act) in their rural areas. Comments on the mentorship using videoconferencing include, "I was able to provide the mentoring without a two day trip! The picture was so clear it was like being there without the travel!"

Applications of videoconferencing technology have been described in this article. Clients who have remedial needs in the post secondary environments of Vocational Rehabilitation education and employment goals and settings are being met as never before. Clearly, this is a one-state evolving program, however, the implications and the possibilities for service provision are endless. Utah's model currently includes, but is not limited to: tele interpreting, tele vocational rehabilitation, tele mentoring for sign language interpreters, tele counseling (tele-psychiatry), tele case management, and tele education.

Discussion

Serving individuals who live in rural areas is difficult, and serving the Deaf and hard of hearing population is even more complicated. Those complicated needs include the lack of service providers, both those who can sign directly to the client, as well as interpreters who can facilitate communication for the client. The use of the described service provision model can help providers and consumers meet the demands of rural issues, Americans With Disabilities Act (ADA) issues, and cultural sensitivity issues.

It will continue to be a challenge to provide appropriate services for the Deaf and hard of hearing population. However, through videoconferencing technology the challenge is being addressed. It would appear that further research aimed at measuring how technology improves employment and independence would be worthwhile. The long term effectiveness of the model could be shown as its impact on the independence and employment status of the individuals served is monitored and documented. Additional research in this area is suggested.

The former Assistant Secretary of the Office of Special Education and Rehabilitative Services, for the U.S. Department of Education states, "For people without disabilities, technology makes things convenient, whereas for people with disabilities, it makes things possible" is certainly true in the State of Utah and the Deaf Teleservices Model. The Assistant Secretary continues, "... this fact brings with it an enormous responsibility ..." (2000). This working model holds great possibilities for the under served Deaf and hard of hearing population.

As this model continues to evolve, the responsibility the Assistant Secretary emphasized must be taken seriously. As rehabilitation counselors, mental health counselors, interpreters, and other service providers use this technology they hold an enormous responsibility to this population to see that the Deaf and hard of hearing are no longer "catching up" to the "hearing" population's use of technology. Leaders hold the keys to looking at ways this type of technology can be implemented. Thus, this article has described a working model in the State of Utah that looks at some of these issues and attempts to find answers. Through the use of modern videoconferencing technology, Utah has begun to find some answers that may prove helpful to the client, practitioner, educator, rehabilitation counselor, administrator, and policy maker, when working with Deaf and hard of hearing clients. More focused research is needed to determine how this technology can facilitate the employment of the Deaf and hard of hearing population.

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