Unedited Session Transcript

What Does Mental Health have to do with Transition Issues?

Lynnette Johnson & Kristylynn Brady


>>: Okay. Let me get back to my story. Last December I went skiing-I love skiing- unfortunately I took a fumble and broke my arm. I went to the emergency room and they checked me out. The ER doctor noticed that I did have a fracture in my arm. There was a break three quarters of the way through the bone. It was still partially attached. So the doctor explained what I needed to do. To be careful. I needed to see an orthopedic specialist to make sure worse problems didn't develop with all of the specialized things. So I went to the specialist and I said that I had broken my arm, there was a crack in my arm, had he asked me what had. He asked if I had the x-rays from the emergency room. And I did so I handed those on to him. Then he started telling me about the break that I had. He told me it was very important not to move my arm. That if I moved it it could pull something off of the joint. If I-the bone could have moved because there was only a little bit of the bone still attached. I didn't think that sounded so bad. I would have noticed if it had broken all the way through but I was careful.

After about three weeks I started doing more and I started noticing-since I am right handed, I sign with my right hand-it was difficult for me to sign with my left hand. After three weeks I had an x-ray and the doctor said I was healing well. I went back after six weeks and the specialist said, well, you know, you made some improvement. But-there's still a little bit on either edge that's not healed. The center of the bone is healed but on the edges it's not. I looked at my x-rays and it looked like my bone healed all the way across. So I asked him what he was talking about. I wanted him to show me where the bone wasn't attached. He indicated there was another crack at the top of the shoulder joint that ran across the back and that crack was complete. It had broken so that a piece was free from the arm bone. And that was after six weeks. He hold me originally to be careful and I was thinking because of the crack in the major part of my arm bone. But he was talking about how the muscles could have pulled this other little piece of bone away. If that had happened I would have had to have had surgery.

The point of the story is that I was going along thinking I had this one crack which was true but I didn't know about the secondary crack so I had been proceeding thinking about one of the cracks in my arm, doing the behaviors that could have been risky to this other crack. I could have easily pulled that bone away from the top of my arm bone. So what I want to emphasize here is that it's really important to recognize that doctors look at one thing, but the patient may be looking at something totally different. I only knew about one of these cracks. I didn't know about the second crack. So in the first part of my presentation I want to talk about what's an appropriate approach that the therapist may be looking at something different than the patient. The doctor was looking at something different than I was talking about. They didn't explain to me the consequences or the entire situation around my injury. Fortunately things worked out well but it's important to provide accurate and appropriate diagnoses so we have the appropriate treatment plans.

Finally we have our power point up. Thank goodness. This is the main goal of our three our hours together. Our paradigm. Proper diagnosis leads to proper intervention. To help you understand a little bit more clearly how this relates to mental health diagnosis, now that I've given you my medical story as an example, I'm going do talk about a case study. A female client, what her presenting problems were, -- this patient had been going to mental health therapy for quite a long time. The diagnosis was that she had delusional disorder. Our guiding paradigm for today is-I assume that most of you don't have a lot of mental health experience? You do? Okay. Let me ask before we start. Who in the audience, I know who is deaf and who is hearing, but who is very familiar with mental health issues? A number of you. Okay. Who has no idea- this is your first experience. Several people. Okay. So most people are somewhat familiar. Some have very little exposure. Okay. Let me give you a little bit of definition here. I assume that most of you will know about it but let me tell you a little for those who don't know.

When you diagnosis people with mental health issues there are five axes. The first is depression, anxiety, mental health issues, whatever. The second axis are personality disorders. Mental retardation, things like that. The third axis are medical problems related to the first two. The 4th is how it affects socialization and 5th is how it affects their functioning. And the ratings are zero to a hundred. 100 means functioning in an exemplary way. Zero is not functioning at all. Most people who are getting along pretty well in their lives are rated 85, 90. We'll focus on Axis III. Let me tell you a little more about this client. Her diagnosis originally was delusional disorder. She felt like people were out to get her. Mostly related to food. She felt like people were putting things in her food. Axis III, deafness was listed. Axis four, she was unemployed, inadequate finances, no support network, she didn't socialize with other deaf people. She didn't socialize really with anybody. Her current GAF, her axis five, was 31. This is a basic definition of what Axis III represents. It talks about general medical or health conditions that are potentially relevant to Axis I, the mental health disorder. Now, we're going to be talking a little bit about is the person deaf with a big "D" or a little D. And does little D deaf relate to mental health issues. I'm going to let Lynnette talk a little bit.

>>: Before I go ahead, I'm wondering what kind of work you're involved in. Education, voc rehab? VR? I see VR people. Counselors? And education? Schools. Okay. School. Right. And what else? Services? Deaf services. Interpreting Counseling. Okay. Okay. So, as a VR counselor you get reports with these sorts of things listed in them, different axes listed in your reports. So I was thinking before I came here about getting reports and different-diagnosing clients and the appropriate rehab sources for these people. So I filled it out and cents it in as we normally do. And I'm trying to figure out the appropriate intervention in terms of educational services or job training, which is going to be appropriate for the person-so, maybe needing some more education. Maybe the person is already educated. So we want to make sure we place the person for appropriate services. I wanted to check in to make sure we're on the same page.

Before I used to work in the ER. And my job there was a crisis intervention specialist. So, --.And it can mean two things. One relating to a person who is very injured, near death, and working with them to try to figure out-working with their family. And the second part is working with psychotic people. If the person is delusional or that sort of thing. One day I was working in the ER, the doctor called me in and wanted a psychological consult. I met with a man who was there. I had four guards with me who said be careful, this person is really crazy. I said fine. There are four guards here. They're here to keep me safe. So we went into the ER and said hello to the person. He had a book with him and he was clutching it to his chest and not wanting to let go of it. I said hello, sir. He said I am god, sit down. I said what's your name sir? He said I am god. Sit down. He was sort of pacing around the room, back and forth. And I knew I was not going to sit down, no way, but thank you any way. I started asking him some questions about what happened and what was going on. He kept repeating "I am god. Sit down".

This man was from Bosnia and his son who had driven him to the ER was telling me that his dad was having problems, something was not right with him. And was not relying on his son as an interpreter. So, I asked the son what his father was saying and what was going on. And they were speaking in their native language. And his son was saying that my dad was saying crazy thing. I said what kind of crazy things. What's the point. He said I am-he said he was saying I am god sit down. There wasn't an interpreter there in that situation. So I knew enough to know that the dad was completely psychotic and needed medication and intervention and needed to be in a hospital. It was obvious. But I had to rely on a different kind of interpreter than I was used to working with. So I did some paperwork and I was trying to figure out where to place him for intervention. What kind of intervention he needed. And so I was wondering what you want to use. So we did the paperwork that was required. Filled that out for the hospital. And the man was hearing. And on my list-on my diagnosis four we had to write down what was wrong. It wasn't that he was Bosnian. That wasn't what was wrong with him. He was obviously psychotic. So this was important. I wrote down what he was saying to me.

And I wondered do I diagnose the person as Bosnian? Of course not. The man had mental health problems enough not because he was Bosnian but because he was psychotic. So now looking at a deaf person who-I've worked with hearing professionals, with nurses, psychiatrists, with doctors, and the first time they meet a deaf person or a deaf client, maybe the deaf person is depressed but the hearing people says oh, all deaf people are the same. I have to let them know they're not. They're depressed. But deafness is not their problem. Or often times a hearing professional will overlook what the deaf person's problem is. Maybe they have an apparent disorder that causes things at work to not go well, or at school, or a personality disorder that can make things go awry. So if they're deaf that could be a misdiagnosis. So I have to go they're-being deaf is fine. They have good job and relationships with people at home.

Often times what happens with professionals they say that with Axis III, because they're deaf, that that's then related to the Axis I because of the guidelines saying the medical condition is related to Axis I. So the person is depressed because they're Bosnian or because they're deaf? Could be. Or the person is psychotic because they're deaf? Are they related? Is there a causal relationship there? So that's one example. But now, looking at it from a different perspective, that someone in the hospital said, yes, if a person is deaf you always put down deaf on Axis III but is this related to Axis I. Does this make sense? Just want to make sure we're on the same page. Okay. Thank you. So now for the second-that's enough for the second part-we'll move on to the second part- I'm sorry. You want me to move on?

>>: Okay. So now an-the example that she had just talked about, the Bosnian fellow-sorry, my finger spelling is just awful. It's the same in English as in sign language-it's just spelling. Now the fellow from Bosnia, of course his language is not related to the Axis I diagnosis. And I would like to talk about another example. Someone who grew up hearing and socializing and functioning in the hearing world. And then as they grew older slowly lost their hearing. I'm talking about my grandfather. He's a great example. He grew up in the hearing world and had a job and a wife and gradually as he aged lost his hearing. He had hearing aids but didn't want to use them. But then eventually was willing to use them.

My grandmother thought great, now he'll hear better. But he had a hard time and couldn't hear a lot of things so all sorts of problems went along with his gradual hearing loss. As this happened his personality started to change as well. So later in life there are different things that go along with deafness. Depression, the need for counseling. And the reason why could be related with the fact that he had become deaf, because his social support was not there any more. My grandmother loved to socialize and loved to invite people to her house and to have large parties.

As my grandfather's hearing declined he wasn't able to join in the conversation and sat by and nodded his head and more and more withdrew. He wasn't enjoying being social where as my grandmother just loved that. That caused a lot of problems. Because my grandfather withdrew from the social situations he became more isolated. He was still considered a hearing person but his ears weren't working right so he had this conflict with the fact that he could not hear but was a hearing person. And he was an accountant and didn't have the need to interact with a lot of people but using the telephone became more and more challenging for him and as this occurred he became more and more depressed. So in that situation the Axis III is directly related to his depression. The reason he was depressed was because of his hearing loss. So it's appropriate to put the hearing loss in Axis III because it's directly related to the cause of his depression. If his ears were working fine he wouldn't be depressed. So in that situation it makes sense to put the hearing loss in the Axis III diagnosis.

>>: Does that make sense to people? Do people understand the difference between the two. If a person says I'm big D, culturally deaf. That's probably not related to their depression. They may be depressed but it's probably not related to the physical condition of being deaf. They may have lost their job or lost a member of their family. In the situation where the grandfather lost his hearing late in life it's pretty normal to be depressed. There's a causal link between Axis III and Axis I.

That's kind of the point of our presentation today, how can we look at the multimodal diagnosis and how can we get other medical professionals and VR people and other professionals we work with to look at it with the same pair of glasses we're looking at it with. If gives you a totally different viewpoint when you look at the causal link but it affects how we interact and give intervention and what treatment whether it's educational settings or job training or therapy.

Another thing that complicates this is that frequently now we're seeing people with cochlear implants. So once again, where do you put that in the diagnostic scheme? I don't know a lot about cochlear implants but just basic information. Does it tend to be big D deaf people or little D deaf people. It could be similar. It could affect that identity. It changes a lot of those identity issues. And if somebody's depressed or frustrated there could be a lot of issues coming up related to the cochlear implant. We're not going to get into that but we see that more and more as well. So if a person cannot hear, you know, if they grew up hearing and lost their hearing later in life, that could cause a depressive disorder. It "could" cause. They may have been fine all along. Physically healthy. Mentally healthy. All of a sudden they have a hearing loss and can't interact with their family, social work, can't function on the job if it requires a lot of telephone work for example. That could cause a depression certainly.

So I'm not trying to say you should never list deafness as an Axis III disorder. If it's linked to Axis I it's appropriate. If not it shouldn't be listed. Now here's a different set of glasses. A different way of looking at diagnoses. With a culturally affirming approach. That's what we're seeing. Deafness is a different culture. It's not a disability or disorder. It's a different culture. We can affirm that culture through the diagnosis process. Before we talk about this, I'm going to talk a little about the woman I first started talking about at the beginning of the presentation. She was delusional. Psychotic, felt like people were poisoning her food. That was the person I first talked about. Let's talk about this situation with a culturally affirming set of lenses. Perhaps this person had post traumatic stress disorder. No mental retardation or Axis II diagnosis. I wouldn't put down deaf as an Axis III.

When I first talked about this woman, when I got the report on her, people said that she was delusional because she was deaf. When I met with the psychiatrist I said are you telling me that the deafness is the reason why you think she's pair annoyed? Why she thinks that people are putting medication in her food and so forth. He said, yeah, because she's deaf. Deaf people tend to be paranoid. Do you agree with this? Are the deaf people in this room paranoid? Do you think all deaf people walk around thinking everybody's out to get them. I tried to talk to the psychiatrist, it's my job as a consultant to try to advise these people. I need to talk to one of the top mental health specialists in the country at the time and try today bring this up in a nice way. I wanted to get that deafness out of the Axis III diagnosis but have it reflected in the Axis IV diagnosis with all of the other issues. She was unemployed for six years, didn't have enough money, didn't have enough support network, not enough friends and family. Because everybody thought what's wrong with her? They were avoiding her.

This is the crucial piece. She had lost the support of the deaf community. She stopped going to deaf events, deaf clubs, she stopped socially where there were people from the deaf community. Her social ties were gone and she became more isolated. So that's where the deaf community shows up, in her Axis IV diagnosis but not Axis III. Sometimes people get frustrated with not having enough interpreter services. That could show up in Axis IV. Client is frustrated due to a lack of appropriate interpreting services or whatever. So it can show up in the diagnostic scheme. It depends on what the purpose of it is though. So, I'm not saying it should never show up with the diagnosis but I'm questioning whether it should be in Axis III. Is the psychosis causing social problems that should be Axis IV. So we need to look at it from that sort of viewpoint. When you see a deaf person, do you see this person as only being deaf? I probably am preaching to the choir here. This is not the right group to lecture about this. You already know this and are experiencing this. So, -- but you already know there's more to it than just the ear. It's a holistic view of the person. There's a whole person that needs to be looked at. And I would suggest that people are more psychologically complex than just their hearing mechanisms.

My supervisors' daughter is miss deaf Utah. They went to the airport last summer I think, because that was when the Miss Deaf America pageant was I think. Any way, last year she was going off for the pageant and she had her suit case and she was with her mother who's hard of hearing-my boss-and they brought their whole entourage and everybody was signing, right? Deaf people signing as they do when they get together. My boss looked at me and said, you know, all of these people were gorgeous. Miss Deaf Utah, all of her women, they were all so pretty. Because they were all past Miss Deaf Utah's coming to send this girl off. And everybody was watching them. And seeing them all as just deaf people. She had her sash that said "miss deaf Utah", that was part of the trip. She wasn't wearing a ball gown at that time but she was wearing a suit. But people didn't look at them as what they were, they looked at them as deaf people. This whole huge group of attractive women, this is a big deaf and it was only look at all of the deaf people. Look at all of those ears that don't work.

So we need to look at them as more than just the ear. More than just these people are deaf. So, do we want to see people-you know, do I see a deaf person, a deaf client, another deaf person that I mean as a member of a linguistic and cultural minority? Somebody who has their own language and belief system. Is that a person that I see? Or do I see this person as a tragic infirmity? So heart breaking that this person can't hear. How are we going to look at people? That affects the way we interact with them and affects the interventions we provide. You have to decide. That's a decision for each of you to make. Which perspective you will take. That brings us back to the beginning. What we said originally. If we're properly educated-or if we make the proper diagnosis, that will lead to proper intervention strategies. If the doctor in Kristylynne's situation had said, oh, you've got a broken arm, let's put a cast on your leg-of course the doctor wouldn't do that, but -- maybe the doctor would have said, oh, we need to remove your gallbladder. That would not have been appropriate intervention. But the proper diagnosis led to proper intervention.

We need to do the same thing. We need to diagnosis people properly to see whether deafness belongs in Axis III or not. Once we have the appropriate diagnosis we can provide the appropriate intervention. This is going to impact placement, vocational education versus employment, that decision. Social relationships, mental health, functioning level, independence-with the goal of quality of life. How much potential does that person have for quality of life. And this is the end of the first part of our presentation. And just want to let you know that this is part of what we've-what we've been doing has been funded by a grant from the U.S. Department of Education. We have to put a little plug in for the government there. They've been providing us with money.

>>: I want to go back to my first comments. If you've got appropriate diagnosis in place, intervention is going to be different. The woman who was psychotic, once she was on medication things got better. She had been going to the hospital, to the emergency room, repeatedly. And once we had an appropriate diagnosis in place, an intervention plan, people started working on her history and her PTSD. She stopped being anxious, stopped showing up at the emergency room, stopped having delusional thoughts, eight better, got back in the deaf community, developed some relationships there. It's not a perfect situation but it's a long site better than before. So she was able to be provided appropriate intervention once she had an appropriate diagnosis in place. That led to a better quality of life. Better functioning. Thank you all. Oh, first, I'll ask if there are any questions from the audience. None? Okay. We'll take a break now for five minutes or so. Come back and we'll begin our presentation again. .

>>: We're trying to get the heat turned up a little bit in here. They're working on it. Hopefully soon it will help. So the ice will melt off your ears. Welcome back everyone. I'm glad you all stayed. Nice to have a little bit of a break to stretch and get your minds woken up a little bit. The second part of our project, part two as I call it is-in some ways it's totally different than what we just talked about. You might be wondering how this connects with what we were just telling you. So it relates in some ways, so bear with us. You'll get the connection. Oh, hold on just a second-just a bit- I don't know if you can see this logo down here. But we're from Utah. And this is the logo that we use-everywhere, for everything that has to do with the government. So this is the logo that you'll see. And on the logo it says "where ideas connect."

I was on the Internet recently on the state web page and they have that logo and statement there too. Where ideas connect. I wondered about that. I wonder if they connect for hard of hearing people- hopefully this is the way that the deaf and hard of hearing community can come together and level the playing field. So it's not just a logo for the hearing part of the state but also for the deaf and hard of hearing community so they can connect as well. This it -- some people may think oh, that's a pretty picture. But I look at it quite seriously. Where ideas connect. I want that to happen for deaf and hard of hearing as well. Here are our names again. We have to put a little plug in. Okay. Here we go. We were talking about the diagnosis in the first part of the presentation. And we'll tie that in here. Here we have a student-experiencing panic attacks. Some interpreters sign it this way. I've never seen that sign but the interpreter who was doing that, thought, well, maybe she had experienced panic attacks herself and knew how it felt. Others use this sign. I've seen deaf people in deaf communities sign this way. It doesn't mean paranoid. Often it means panic. So it's interesting seeing the different signs. I typically will spell panic attacks but want to make sure you're on the same page with me. Everybody get where I'm going with this? All right.

So, college student, experiencing panic attacks. Bright student, she has her four year degree, she's in graduate school. She's a deaf student. And then he she starts experiencing panic attacks. The issue is complicated. Because she's profoundly deaf. It's an audiological problem. Not a diagnostic problem. But she is deaf. Culturally deaf. She lives in a very rural area-this is the sign we use in Utah because there are many farms in the area. Some people I met from Alaska told me their sign for rural. And Arizona sometimes they'll say it like this. Okay.

So, she lives in a rural area. Frequently there are not a lot of human services. Not much connection with the community. In big cities there's big communities. In rural areas there are no interpreters and not a lot of services available. The client uses interpreters in her classes as well as note takers. And the disability resource center, the DRC, whatever you call it in your local college, they're having a hard time even getting interpreters for her classes. All of the other issues that she may be facing, there's just not enough attention for that. Getting one or two interpreters that can be placed on a consistent basis in there is hard enough. Some of you have experienced that before, right? It's common everywhere. No matter how you sign it it's a common experience.

We all know, it's true, that there aren't enough interpreters. We all know that the Americans with Disabilities Act requires that we have qualified interpreters-that's the word used in the ADA- "qualified" interpreters in a variety of settings. And there are not enough of them. They have to be provided in post secondary settings. When you're struggling to place interpreters there. There's also a shortage in the community for mental health situations, voc rehab situations, if people want to go buy a car, on the job, anything that happens a to z with their life. A lot get placed in educational settings so there are even fewer for other situations. So she is deaf, she has a mental health disorder, her panic attacks. She was starting to feel like she was having a heart attack. You know what that's like. The heart racing, vision blurring, seeing Stars. Often people present with systems like a heart attack and it takes medical intervention to see it's not a heart attack but a panic disorder. She has additional multiple disabilities. Maybe she has a learning disability say. She's very bright but maybe she has a learning disability as an added barrier. Plus she lives in a rural setting. So what do you do with this person? I don't think we in Utah are the only ones facing this. I think all of you, I see a lot of head nods, are experiencing this. That need more services. How can you provide services to them in a better way than we have before.

We need to come up with a new way of approaching this to do a better job. So we investigated some technological avenues. Researched a number of different products and we found that there is technology available that would be very helpful in this situation. Not only this situation but many others as well. Particularly with deaf and hard of hearing people. The idea is that we want to connect these ideas to provide services. What we're using is Polycom equipment. It's a brand name for a particular type of equipment. And the rest of our presentation will talk about what it is and how it can be used and applied in these situations. What does this look like to you? It's got a TV, and a little camera-it's, you know, about as big as this podium. Maybe six inches tall that sits up on top. That's all it is. A large screen TV with a camera on top. And what you do with it is have conversation. It's just like video conferencing. This is the sign we use for video conferencing. You can interact both ways. This guy talks, this guy talks, and they can both see and hear each other.

The equipment that you need at each site is a Polycom unit, the video conferencing unit, this camera on top of the television. In our state we use a dedicated t1 line. I'm a social worker, you have to understand. I'm not a technical person. But I've been trying to keep up with my learning about these technological issues. Because, you know, if I don't learn about the technology I'm not going to learn about the things that will help my clients. How many of you know what a t1 line means? A couple of people? Maybe four people in this room. Okay. It's called a dedicated t1 line. We also additionally have a DVD or VCR and we use that for some of our applications. It's not something that's required for this to work but we have that. And then television. It's very simple. Okay.

Here's the information about the t1 line, for the technology impaired. Which includes myself. I consider myself technology impaired in the past. I still sometimes do. This is like a totally different language that I have to learn. And frequently I don't understand what people are talking about. So as a technology impaired person I'll give you a little information. These are pipes. You know, usually pipes. You can have little pipes, wider diameter pipes, big huge massive pipes. That's a similar idea to what computers use. If you've got a really thin pipe you only get a trickle of water out the end. If you have a big huge pipe the water flows through it quickly and you get a flood of water out the other end. So if you have a computer at home and you have a 56 k modem, you can connect to the Internet, 56 K. The number on that is very important, especially relating it to sign language. 56 K is like a very, very very small pipe that only a little bit of water can get through. If you have a dedicated t1 line it's like having a massive wide diameter pipe that water can flow through very quickly. Lots of information. So we have a big huge pipe here. A t1 line. More room, a bigger pipe, plus more information. Because we're not putting water through this pipe. We're putting information through this pipe. And sign language has a lot of information within it. It has movements, facial expressions-we're not talking about just the hands but the mouth, the hand and the eyes-all of that has to go through this pipe. So there's a lot of information embedded in watching somebody sign. All of that means that having this big pipe, this t1 line means you'll have a better quality, a better picture. The flow, the picture of the signs.

Some of you may have used VRS, video relay service, there's a little different technology involved with that. But sometimes it's jerky or disjointed. It's great that people have access through that but the signs are sometimes not too clear. When you have this huge pipe the signing is as clear as if the person were in the room with you. It's really wonderful. With that equipment, we thought we were going to start out doing some research. And I found that in the state of South Carolina, there's a woman who is a psychiatrist who signs, strangely enough. How often have we had a psychiatrist who can sign. So she was meeting with deaf clients all over the place. Then she got married. Then she got pregnant. And she wanted to be a stay at home mom for a while. But the state of South Carolina kept saying you're the only signing psychiatrist in the state- maybe in all of America, maybe in the whole world, we don't know. But we need you. And she thought about what she was going to do. You know, she wanted to stay home with her children for a number of years. She proposed that they put the system in her home. It was a different system than I just described to you, but it was a TV with a camera and it allowed her to work from home with her client. She could stay home with her child and continue to be a stay at home mom. That was an agreeable situation for her.

I've never used this service but my understanding is that she's now providing these services in very rural areas. Utah is similar to South Carolina in that there are a lot of rural areas. Sometimes she would have to drive for six hours to meet with one client. There might be only one deaf client in that part of the state but it was somebody who needed mental services. So instead of driving six hours by using this technology she could do it from her home. Pull it up on her screen, interact with the client, be able to see the person but without having to travel, spend money on gas, stay in a hotel sometimes. It was a big innovation. So that's how we started our research. We saw it happening in South Carolina but they were the only ones really using this. They were calling it telepsychiatry services. So, it worked well for the psychiatrists in South Carolina. And then two years ago the state of Minnesota started using the same system for the department of- um-the work force department. Yeah, sometimes people sign it in strange ways. Not work force as being forced to work, but as a group of people working-so the department of Worksource, dwf, started using this for interpreting services. They had three sites around the state. If people wanted to communicate with each other they could. If someone needed access to VR or Worksource they would have a deaf person and a Worksource employee or a bws worker or a perspective employer-excuse me -- a perspective employer would be sitting together in front of a television screen with the camera on them and then somewhere-I see the guy back there with the two women?

Maybe they live in a community where they have an interpreter back at that table and that interpreter would have a video camera on them and the deaf client and the employer could have a conversation using the interpreter from a remote location. Minnesota did this for a number of years on a small scale. I went to Minnesota and asked them how it was going. They said it's been going well for two years, the technology is still fairly new. Minnesota was using it for remote interpreting services. South Carolina was using it for remote psychiatry services, and some places were using it for education. So I did research on each of those am equations but it seemed to me like, well, if you've got that equipment, I have it in my office, you have it in yours, it's just sitting there. I use it had once for the psychiatrist and then it's not used. So it's not cost effective and the benefits aren't that great.

So it got me wondering if we've got that equipment and have it placed around the state, why not use it for a whole range of services for deaf and hard of hearing people. That would really be connecting the scales. We could have tele counseling-are there any counselors for the deaf here? Do you have RCD's in your state? You sign, right? So, if you've got teleconferencing you can have a teleconference with a deaf person and another VR office who would like to have services but there may not be anybody in the office to provide them. So you could have tele-VR counseling. Tele interpreting. I talked about that in Minnesota. Here's another idea though-interpreter mentoring. In my state we have-we have a little bit different interpreting certification systems. We do have the nationally recognized system. But there's also a state system that with can work their way through the first level and up to the second and third levels. It's a three tier system in our state.

But the point is how do interpreters improve their skills in order to work up. If they're-if they like where they live they may not want to relocate to areas where there are more people to improve their skills or get more education. Moving may not be an option to them. They may want to stay in the rural area that they're in. The state has to provide training for skill improvement. The state system, if interpreters can't work their way up to the second and third levels, if their skills are not improving, their certification can be removed. The question was how to provide them mentoring and improvement. So we thought about this system to mentor interpreters. That was a very interesting application. I would like to get more into that. But I've talked to people about this idea. And people keep saying, oh, you can use it for this, that, this other thing. My answer is, yes, let's give it a try.

It's been interesting to find different uses for it. Education is another obvious use. And case management as well. We're talking about working with low functioning people. You know what I mean. Low functioning people. Politically it may not be the best term, the best sign to describe those people-what did you say? Visual people. Visual, gestural people. Whatever. You know what-you understand what I'm talking about, right? I'm trying to be respectful but I want you to understand what I'm saying as well. Sometimes they have to fill out these forms or do these other tasks. They may not be literate in English. It may be a challenge for them. If there's a case manager who can sign fluently with them and match the level of functioning the person has, they can do that through video conferencing. The case manager can have the form with them and they can interview the person, get the information about background, parentage and so forth and fill out the form. If you add a fax machine, they could fax it to the case manager, they could fill it out and fax it back. The point is there's not only one service provided. There's a whole range an it's being used on a regular basis. .

>>MALE SPEAKER: I wanted to ask a question. I've been thinking about what you've been saying. With your psychiatrist example, you have a meeting through the video conferencing, I have several questions at the same time. Hmm-let's assume that the deaf client has their own Polycom set up. I work in a rural area as well. A lot of people are not able to form that-to afford that kind of equipment. It is expensive. Do you have it set up in a particular location?

>>: Yes.

>>: So you'll talk more about that?

>>: Oh, yes I will.

>>: Is the psychiatrist prescribing through the conferencing? How is the transcription sent-

>>: I'm so happy you brought this up. I want this to be an interactive session. I want to talk about some of the services but-we have various sites throughout the state. I grew up in a rural part-there were 21 kids in my graduating class in high school. So that tells you what kind of town I grew up in. It was an agricultural area. For example, grocery shopping, we did not have a grocery store so we would have to drive to town -- so to speak. That's what we call it. Going to town. That time we had a doctor, a store, 8,000 people there. That was really the big city. That was really important to me as a kid. So that's basically "the town." And I lived 30 miles from town. So we would go back and forth to town to do our shopping at least once a week. Maybe once every other week. Fill up a few cars and then bring it home. So that gives you an idea of what kind of rural area we're talking about. So that's my experience. So a lot of places do have towns so to speak. Where do people go to the doctor's office, where do you go to do your big food shopping. As I said the town I grew up in didn't even have a grocery store. We had a post office, school, post office, and that was it. So that gives you an idea of what we're talking about here. So how that concept of town relates to Polycom sites is that we've set up this equipment in "town" for a lot of rural areas. Eventually it will be available for all use. The price will come down. So you ask people where's town for you. Where do you go shopping, to the pharmacy, to the doctor, and then we set up a site there to put that up and that's where people can go ahead and access our services. They have an appointment there, they go in-let's say-what are you exactly? A counselor?

>>: Licensed clinical social worker like you.

>>: Good. I need some counsel he willing, come on. Bad things happen at my school. So I go to town. Whatever town that is. A town of 8,000 people. And then you are in some other town say six hours away from me. I go 30 miles and you're in your town. Which is-let's say 18 hours. For example Alaska. You're too far to come to me and I'm too far to go to you. So we go basically to a central location. Does that make sense?

>>: Let me add something. I go to the doctor's office often and I'll call and say I'm almost out of my medication and they'll just call in the pharmacy to give you a refill. I think it works the same way with psychiatrists. The-if the pharmacy is four hours away I believe they can call the pharmacy. I'm not exactly sure how the system works but I think there are some details that could be worked out.

>>: Regarding this video conferencing, what if there's a huge problem with a client. Perhaps they're suicidal and their psychiatrist is so far away, how do you deal with that crisis.

>>: That's a good question. South Carolina really has a great set of services available. Utah is still in our infancy. South Carolina's about fifteen or twenty years-how they deal with their protocol and process for that kind of thing, frankly I'm not very familiar with it. But basically video conferencing is done. In Utah for example, we have various sites set up-they're pretty much regional throughout the entire state. And it's in some kind of a professional office where there are professionals near by. We have four sites in Vocational Rehabilitation offices. So there are VR counselors on hand. And if the client is receiving video conferencing and it's not getting anywhere, primarily VR is all about employment, independent living, that kind of thing. And then during the video conferences we realize that a person is at risk to themselves or others, we call directly to that particular office and alert them. Excuse me, we have this person here-we talk to who ever the key person is, the point person, whatever you call them. Someone responsible for the protocol in the office, policies and so forth. You call and say excuse me, we have X person. I've had that happen. We do kind of basic counseling but that's a really good point. That's part of counseling actually. There's the person. But you do have point people at various sites who can assist in that situation. It also depends on their background.

>>: In a person's home that would not be a point person but I've thought about that too.

>>: That's a really good point in terms of mental health and a whole range of services. In South Carolina they have stacks of protocol and policies and manuals about what to do- if if if-they have a list of referrals to give to a person or whatever. They have a lot of information available-they call theirs the tele psychiatrists. Not teleconferencing. That's their label for it. They have manuals on what to do abc or d. We're learning a lot from their experience. We do point counseling. But if it's in a person's home, I don't know. I don't know if they would do it or not. It's a good point. Something else regarding Medicaid, I have to ask who pays for teleconferencing. Payment is a big issue. Who do you go to for that. I talked to one hearing person who actually signs quite well, and they said Medicaid pays. Oh, sure. You should ask your state. So I did. After I spoke to South Carolina I spoke to the state of Utah. And I said I heard Medicaid pays for that. They said absolutely. So we don't have a problem for that in Utah. We never had it in Utah before because nobody ever asked. They're already paying for interpreters for a lot of other things. So they have a person that they pay. Of course that's the best thing. In case that's not available, you provide the best you can. If that's a counselor that's fine. So Medicaid does pay for the tele counseling. They have some guidelines that they have to follow. In the case of where the incarcerated person was quite dangerous, they have that experience. But it's relatively new. I was really surprised that Medicaid will pay for that service. That's a good thing. You had a question?

>>: I had the same situation in Alaska. A person called from a remote village and said he was going to kill himself. So I called the police to do a welfare check on the person. I didn't really know what else to do for that person.

>>: So you called 911 from your area.

>>: Yeah. The person called me at home and said I'm going to kill myself. I didn't know what else to do. I said hold on a moment please. Be patient. I felt I had a duty to report to the police.

>>: Did you do it through tty or teleconference?

>>: Tty. The tty, it was pretty emotional, I could tell from that.

>>: So those are things that South Carolina offers. They have manuals about that and their protocol. We're still developing ours. We're in the process of developing that in our state because we're new at it. Also it seems there's a standard protocol with counseling. You have a client, you fall back on the counseling norms that you have already and try to make the application more broad. Very good points you brought up there.

>>MALE SPEAKER: They pay for the counseling and the use of the equipment?


>>: We received grant money for that program. That's specifically for deaf and hard of hearing services. We're trying to do some testing trying different things and we-the grant was for the equipment. The hardware. The wiring and the Polycoms. Now the services as this woman talked about, paying for the services is a whole separate stream and issue. The grant funded the hardware. Not the actual services. The services provision is a whole different ball of wax. Some different issues are there. I believe we can back up a minute here to talk about that.

>>: This is about a $3,000 piece of equipment here. And then the TV costs whatever they cost.

>>: I have a question. Excuse me-my husband works for IBM and they have that kind of system and they bought the entire thing for $7,000 but it was really the top of the line. With a dsn, itn line. Not t1.

>>: The initial investment is the biggest cost. To buy the equipment. And then actually running the equipment, the monthly cost is, you know, we just started this here. We just opened up this year. Our sites-now some of you as I said are out in rural areas-it's like $140 a month. Just for the t1 line. The dedicated t1 line. That's $140 a month. It's a maintenance charge. We've done a lot of partnering and made a lot of agreements with companies to reduce the cost but that's what we've come down to. And in the rural areas it's $140 a month and where I live it's $200 a month. $140 a month to keep it up and running or drive nine hours, stay in a hotel, eat their meals, have a consultation, meet with one client and then drive all the way home, nine hours. If you look at the wear and tear and the cost for transportation, would that be more than $140? I think it might be.

>>: The grant-where did you get them-

>>: Okay. The grant-

>>: Have you heard of this organization before? Yes? No? WROCC Western Region Outreach Center & Consortia. Based in California. This is basically a subcontractor of the federal government as the national center of deafness at cal state university, north ridge. So the federal grant, they're under federal grants to be the national center of deafness. And the federal grant said we're looking specifically at hard of hearing issues across the country, nationwide. Traditionally it's been to universities and four year colleges. The feds kind of looked at that and said- and the grants run in a five year cycle -- 96 was the beginning of this relationship between the feds and WROCC. After the first five year cycle, mostly two year and four year colleges, post secondary Ed. That was the focus there. And after that grant period was over, there was a new period that began last year and the feds reexamined their mission and asked. What about noncollege bound deaf people. Low functioning people. They're not college material. What about them? So they wrote that requirement in the federal grant and said you have to focus on those people. So they were able to take that grant and not really knowing how to address it. That really wasn't their specialty.

So, the WROCC subcontracted these grants out to different other states. For example, we have a deaf community center who sees a variety of different kinds of deaf people. Basically, college bound deaf people, ncd's are seeing the same kinds of deaf person, and the centers see a variety of deaf people so they wanted to develop products. The focus was on that they needed to be included in the second grant cycle. So last year we received a grant and the site -- and a site coordinator-I'm really-I consider myself much more as a counselor but I was willing to take on the role in this particular situation. I look add at my clients and their problem, again, the focus is on low functioning deaf people. We started doing some research and figuring out what to do with this grant money that we have. How could we make the lives of low functioning deaf people better. That's sort of my specialty. Through research we learned a lot of things. It could work for counsel he willing, interpreter mentoring, a variety of areas that need improvement. So WROCC is the grantor, from the feds through them, and basically we're pilot testing this. I know from doing research from other states, workers at the university of Utah medical center, a regional hospital, people from Montana, Wyoming, Nevada come there, to Utah.

So it's a regional hospital and they use that with hearing people for medical consultation. It's called tele medicine. So they already had that. 28 sites. We just had four. So we're doing this test. Seems that you would be able to leverage their 28 systems with our four. Then the question was do they have sessions in rural areas, and they had their medical centers, so we accuse use their 28 centers that they've already established. We had four. So we're talking about 32 around the state. This way the health centers have them and that's part of the federal health designation. So that's throughout the whole state in Utah. Then the regional hospitals also have them. They have some up there in Montana, so we can go ahead and have tele services up there. We're talking about deaf and hard of hearing services. Wherever in Utah it's where services connect.

The question is with the deaf people. That's the point. So there's a lot- the grant-as we learned more about it and got more information, there's the office of advancement for tele health. That's a federal program. And that has specifically worked on video conferencing. We started here at WROCC and it has opened so many doors. There's so much out there. It's mind boggling. So the office of the advancement of tele health is a federal program. So just to let you know more about that. So the great money is the initial investment for the hardware, the set up cost. And then the actual provision of the services, the medical providers is a whole other issue. But the grant funds the investment. Does that answer your question? That's a good question. Because I was really amazed. I thought we are going to have to provide this kind of services for low functioning deaf people using video and gesturing and what's available out there. So we began researching. Went to the library often. Did all kinds of research. I went to conferences to see what was able. Gee, this is available. How does that work? How does it work in other states. So I investigated all of that and I they said, sure, it's work not guilty these areas and I got a lot of information from them and was able to develop something in Utah. We'll talk a little about the users in our state. What they look like. Deaf people, obviously. Hard of hearing people. After we got this set up, we've got captioning like we have here. Realtime captioning. How this plugs into the computer, sort of connection. I have that in my Polycom equipment as well. It connects directly. So captioning can be sent directly to remote sites. It's really interesting. We just learned how to do that from the people of Minnesota about three months ago. The captioning is sent along with the pictures. Remember the Brady bunch where you had the pictures of people? And the wording it goes over? You can insert a number of pictures on the screen.

About a week ago I sat in on an RCD meeting, rehab counselors for the deaf-there are six of them in my state. One is six hours south, three hours north -- but we all connected for the first time using this technology. People were asking us if they could use this system and we decided to try it out. I sat in on the RCD meeting. We had a large television screen. Say there are six counselors and a supervisor-so a number of people. The district director was also there. And then on the screen-there's a camera that can pan back and forth between the participants. As they watch the television screen they would see a number of different sections of the screen. There were three different segments of the screen with three different sites being projected there very, very clearly.

The equipment has a sort of voice technology so the camera turns to focus on the person who's talking. It activates based on their voice. The person six hours south is an RCD who is hearing. So when she would talk the camera would pan over to focus on her so you would see her on the screen. On all three of the screens. The technology is just fascinating. I'm still learning more and more about how it can be used. I don't know how if somebody starts laughing, would the camera start focusing on them? I don't know. Maybe they would have to mute the microphone. There was one guy who was kind of bored- well, maybe not. He looked like he was. But the camera was on him and we could see him sitting there making faces. He had a big envelope that he was addressing and making quite a bit of noise. Stuffing the papers in the envelope and licking it shut. Then the camera came on him because he was making so much noise doing the secretary duties. Then all of the room started laughing. Hey, join our meeting. He got caught. He didn't realize they were going to see him. But it's the human interactions, the connections, which are natural. I've gathered a lot of data from people using it. Because it is a pilot project. Everybody was saying, wow, we did not expect such live interaction. We use a fairly large monitor-a large television-17 inch? So it's like a person is there. You can see a person life size. It's not this tiny little screen that you have to squint to see like a computer monitor, you can see a person. Interact with them and have conversations. It's really wonderful. When I did research I wasn't sure how it was going to work but now that I see it in action I'm still in awe. The technology is wonderful.

Also talking about the research. The technology access program at Gallaudet University has looked at what the speed requirements are for clear video on teleconferencing. They've found that if you have fifteen frames per second-fps-that means fifteen camera shots within a second-is sufficient to read finger spelling. So, I asked them-again I'm not a technology person. I'm a social worker. But I'm learning the lingo. I asked them to translate for me what fifteen looks like. I'm starting to understand t1 and all of these other numbers. But this fifteen frames per second, what does that mean to somebody like me? I had to write down in my notebook what they told me because I knew I would forget. So let me look it up here. I always have this notebook with me. It's my day planner. I wrote down fifteen frames for second. That looks like 128 or 256 K Internet connection. And a 128 connection-you already know about all of this stuff? You know what 256 is like. So if I asked a technical person what is 384 K look like? How many frames per second the answer was 30 frames per second. So fine. The people at Gallaudet said you had to have at least 15 frames per second. That meant the finger speller had to be a little slower and maybe be more expressive, but it needs fifteen per second. The faster it goes the better the quality.

If you're on a 54 connection that's more than enough. We're using a dedicated t one but you could get sufficient quality with 384 k. You should be able to get that. I've tested without our t1 line because our equipment we can adjust it to lower the speed. I talked to a lot of hearing people marketing this idea and they say oh, it will be fine. But they want to see it. I have to see it myself. Because I don't trust what they have to say. If you put in this nice equipment but the-everyone's signing too fast, maybe somebody's manic and they're moving too fast, you can't read the person signing. So I have to make sure it does work. So I had an interpreter in California and doing teleconferencing. And I said are you going to buy our equipment-set it up-we were having a conversation and oh, my gosh. That was with 384. That was more than enough. According to Gallaudet's research 15 frames per second is minimum. But 384, if you get that, you can do fine. .

>>: I just thought of another new technological development from a company called Sorenson media. They've been using a lot of technology recently for video conversing via phones. They have a technology that only costs $300. Similar to the Polycom. Not as clear or crisp but it's good enough for signed communication. It's only $300. It sits on top of a TV, takes a normal connection like DSL. So you don't need to have t one line.

>>: Yeah, they use a technology called video compression. So, the picture of-if somebody signs that data would be compressed to send through a thinner pipe and it would be expanded on the other end. It's a fascinating technology. We have a he tested out a number of things.

>>: So, any way, it's really neat. It's nice there are different options. There's the Polycom which is cool. Gives you cool, clear picture. There's also Sorenson which is quite good. It can be used well in this situation. There will be more and more products coming out in the near future.

>>: And especially for deaf and hard of hearing people. So often they lag behind in the services they can receive. They're the last ones to get what every one else has. Everyone else has the services they need and deaf people have to wait longer. That's one of the things we wanted to do here was to get the word out. With all of the research we did we found very few deaf people using the technology. Most of the technology was being used for hearing people. Not a lot of applications were taking advantage of this for deaf people. Like I said, the university of Utah medical center is already making use of this. And they have 28 sites around the state. Which is great. But we have deaf people coming into our community health centers needing interpreters and services that we would like to be able to provide. We're using this to provide CEUs for our doctors but why can't the communities provide this equipment for those services. They're very happy to do that.

The hearing community has all of these wonderful applications. We need to just expand that. Moving on. Here are our site partners. You may not be familiar with Utah, so I'm sorry. But we have four different sites. VR offices are three of them. And then we have a community center for the deaf. That's our deaf and hard of hearing center in Utah. They've got about 30 employees there. Outreach specialists, educational specialists-we have somebody from the advisory board here. This is Darlene Cochran. And she has provided services and counseling to deaf people in the areas of independent living. So there are a lot of different services being provided out of that center and the other three centers in the state. Just as I was talking about recently, I met with a doctor just a week ago at the hospital and found you out there was a partnership we could create there. We also have a partnership with the educational setting. The education network already has ten sites set up in rural areas. We're also using the service providers-as service providers, interpreters throughout the state. They're public and private service providers that are providing services. If they are not-if there are not enough services in the area they're called in to provide those services. And also we're serving the state interpreter program to provide mentoring, educational opportunities, continuing education.

Video conferencing is good, having life face to face is better. But if the nearest person is two hours away, then that's the best you can do. If you can have a face to face that's better. Video conferencing has been shown to be absolutely better than not having the contact at all. If you can improve the skills of interpreters in the rural areas by mentoring them, then there will be a larger pool of people in each of those areas. Live people who can go out and provide in person services. There's so much that tele service can do but having a live service is better. There's a federal grant called the do-it center in Colorado-how do you sign Colorado here? I'm wondering? Like this? Okay. In Colorado they have a federal grant for interpreter education and improvement. And so we've been providing equipment, they've provided the services. They had someone fly in from Colorado to give training to our interpreters. Most people who have participated showed improvement in their skills. But people in the rural areas didn't have access to that training. So now we can provide workshops through the video conferencing. So we're looking for any place we can make these partnerships. And we're still working on some other. So here's a little map of Utah. Here's some education partners. From the north to the south. From the head to the toe of the state. And there is-these areas are very rural. Nobody lives there. It's just sand dunes out in this area. You know, the picture that is you see of mars? Military test sites. Just desolate desert. Nobody lives there sort of areas. That's what you get in the far western part of the state. The people kind of run down the center. That's where people live in our state. Through these educational partnerships we have this network so we have access to the sites in these places. And then-the Mojave-the painted desert in that area down there-oh, my. I love biking and camping down there. But if you talk about services for deaf people, there's nothing there. But they have connections so there's access now. So we, in the big city, in Salt Lake City, can have a person who can provide counseling through outreach to the Mojave area. The red rock. And we partner with educational institutions. We don't have a lot of money to do this. But by setting up these four sites we've been able to network with other partners. Now with the medical centers with 28 sites-that's a partnership we're still working on-this network will expand.

>>: This is some background here. There's tele medicine and tele education. This is how we determine what services could be available. And some of the services that hearing people might use. It's used for educational services, health, medicine, for diagnosis-not just mental health diagnosis but medical diagnoses as well. I talked to a woman in the hospital the other day and said what kinds of things are they used for. I did some research. But what do we use it for in Utah. It's been used for some bone problems. So they have a variety of things they can diagnosis through video. Intervention, consultation, go ahead. This word here is key-"support clinical care". Again the protocols are established at the university of Utah. The woman I spoke with said we have a protocol that describes what we can and cannot do through tele medicine. Tele education is self explanatory. Classes are offered through television. This is the Gallaudet Technology Access Program-GTAP that we talked about the fifteen page per second. It's also used for people who are visually impaired. I think that's fascinating. We haven't gone there yet.

Now in Seattle I know you have a lot of deaf/blind people in this region but in Utah we have a really small population so we haven't done a lot of research in that area. A person who is visually impaired- basically we're talking about hearing, nonsighted people as opposed to deaf/blind people. But here in Seattle I'm not sure this would work with deaf/blind people. VR counseling in Montana. Minnesota, I just spoke if about them. They're relatively new. This is video interpreting. South Carolina. This is an educational program and also Florida's as well. So here we can use it for educational purposes, medical and health reasons. The question is could deaf people use it for these three areas as well. And that's just a few. And here's some particularly rural issues. There's a great resource we can E-mail you if you'd like more information about that. The APA style. I can access it if you want to.

So we have these three aspects that hearing people use and we'll connect these ideas-the problem is with these hearing models, I am an education person, tele health person-they're all in separate camps. So we're just making these connections and these other aspects. What this creates is improvement in accessibility. Increased empowerment. And access to service provision so, we can spread ourselves. From this program, the initial cost-well, it was a lot to get the equipment. But after that investment-I mean, the most we pay for a maintenance fee monthly is not even $200. 180 something. Less than $200. I mean, that's the-that's my community. Out in the rural areas it's cheaper. You should think it would be the other way around. But that's the way it is. So we're saving a lot of money on travel. And also the cost of time. That's a lot of money to take out of the budget. I love this picture right here. So we are connected to our rural areas. And this shows you a different application for video conferencing. Primarily we do it one to one. Here it shows a group meeting with a particular person on video conference. We focus on a variety of disabilities and technology-oops-hold on a second here. I want to show this here. This is what it actually looks like.

You connect a second television, you can have split screens-it is just a simple camera really. And finally-ideas connect. As much as if not more than what the hearing population already has. The director of Vocational Rehabilitation for Utah and the director of education for the Utah state office of rehab, the executive director, someone in a very high position. They said to me, if this is not being used for deaf and hard of hearing people would you mind if we use it had once in a while? Of course. It's so nice to be in a position to be able to offer something like that. It's so nice to have it be the shoe on the other foot. The executive saying would you mind if we took advantage of the resources you have for deaf people? Rather than us having to ask. So technology helps us to connect. It's been going on for a year as a subcontract for-that's what we've done. And this is our funders here. Western regional center. This is their web site here. And also we're connected to WROCC. This is our outreach web site. Utah outreach center coordinator. And the grant money originated here at the U.S. Department of Education. The office of special education and rehabilitative services. So, that's it. Should we take a break? Any more questions? You have a question and then we'll take a break.

>>MALE SPEAKER: As a technology impaired person, who does maintenance and trouble shooting for the equipment?

>>: We have a service agreement with the company who sold us the equipment. There's two things-one is from Polycom, it's a service agreement, you know, trouble shooting, that kind of thing. Also because we're partnering with the various educational agencies, they said they were happy to provide us technical support because they use the equipment too for hearing people. So they're basically giving us service in kind. So, again, it's a very nice bartering system. In kind donations. Not always an exchange of money. So we may provide access to various sites. With tele medicine we can come up with interpreters and counselors and they give us access to 28 sites around the state at no charge. So it's a win win for everybody. So that's the type of support. One of the things-if we're nicer to them they're nicer to us.

>>MALE SPEAKER: Do you have to pay a charge on this?

>>: As I said, I'm technologically impaired but-my Internet at home I pay an X amount per month. If I don't use it at all it still costs me the same fee. AOL or whatever. Regardless of what the fee is. Some people have unlimited use. It's the same idea with this. You have the t one line, whether you use it or not. I mean, if you use it 24/7, you still would pay one monthly fee. So it's not a usage charge. If you don't ever use it, you still have to pay. So it's not kind of a usage fee.

>>MALE SPEAKER: You said that hearing people do they pay you for using equipment? You could earn money from that perhaps?

>>: Because we're a federal grant we can't do that. I talked to people with that and it's not worth getting into that. We're trying to develop a service and a model. So we don't charge. But who knows. Five years down the road, because we're doing the research and documenting a lot of what we're doing-perhaps five years down the road at the end of the grant we will have some hard evidence to show to the legislature and the policy makers and say, look, you know, this is how we're using the money. Perhaps we can convince them that it will be worth them investing their money. If we've done our homework, at the end of the grant perhaps they'll help us continue. What it takes is the initial investment and then away you go. Okay. All set with that one? Let's take a break.

>>: Okay. On to part three. I have to tell you, I've never given a three hour presentation in my life. So I thought to myself, three hours, yikes. So it's new for me. Is everybody all right? Are we all in one piece? Do we want to stand up or jump around or anything? This is my first time so I'm happy for any feedback. Thank you so much for bearing with us. The last part won't take a whole hour, I promise. The last part is about this whole cdi issue -- certified deaf interpreters. When do you use them, why do you use them, how, why do you have them? The reason we're-for example, say I'm working with an interpreter for example, and that's not really what we're talking about here. This is not really about interpretation. We're not talking about how really. We're talking more about what is the reason behind using a CDI and when is it appropriate to call in a CDI. Now we're talking about people who are more low functioning. So we're talking about the why and the when. Not necessarily the actual mechanics of the interpreting working. And also the way you can find more resources and information.

Here's some definitions to start with. This word "remedial" you know, I guess it's appropriate- an appropriate diagnosis leads to appropriate intervention-so the word remedial is the word we use for it. We have about 30 deaf staff at the center. We had a meeting one day and I wrote the word remedial on the board. I wanted to get a sense from the room what does that mean. I looked around and it was well, not so sure. They said, well, I'll get you a dictionary. Thanks a lot. I was just trying to get a sense of what people felt that meant. Well, an appropriate diagnosis leads to appropriate intervention, so the question why the term is in there means basically taking it down a step. The deaf community will often sign the low functioning sign. That's the term we have for it. A certified deaf interpreter, those are two definitions. Low functioning are terms that are used. Low language. And you signed before --? Visual gestural people. So basically it's the same concept.

From a clinical perspective, often people would say learning disabled. Or have some questionable cognitive functioning, a border line iq. And we've sort of lumped all of that together in low functioning or visual/gestural people. So the question is what is the exact diagnosis. So, remember the appropriate diagnosis leads to the right intervention. So the question is why does that person have that level, what's the cause of it. Did they grow up in a stark environment, or are they victims of abuse, neglect-there could be a variety of causes an why are they at this remedial level and what is the causal relationship. And here we have the definition-the second definition-I don't have it written here but this is from the web site-www.rid.org-registry of interpreters for the deaf. I had kind of a hard time fitting it all on the slide. So I haven't done that here. But if you look at rid.org to get that exact definition. Pardon me, I have so much paperwork up here. It will just take a minute to find it. Rid defines-CDI-are people familiar with the functions? Do you use CDI's regularly? Anyone used one in the past? Have you used a CDI?

>>: I'm familiar with the concept.

>>: I just wanted to make sure we're all kind of on the same page here. Basically it's a deaf or hard of hearing person who is able to act as a linguistic intermediate year-it's an interesting choice of words that rid uses-a person who uses gesture, mime, props- physical items-you know, like I was just talking about with the camera, putting it on the podium here- drawing, and other tools to increase communication. It's not just a person who's gesturing with their body. They have a lot of other options at the ready. So, we understand the two definitions. We have this remedial deaf person. And we have the CDI. They're pretty clear, those two definitions. And the question is where shall the twain meet and why should you put them together. Often, when you're working with a more remedial person you just use a regular old hearing interpreter. Thank you very much for being here today and thanks for doing all the talking. I appreciate that.

Now, this would not-could perhaps not provide equal access to a remedial deaf person. It may not be access or qualified for that particular person. I mean, they might do a great job. You know, we'd be lost without interpreters. All my love to those interpreters here. But, it might not be the right thing. Sometimes it's just not enough. Perhaps the person has some cognitive deficits with their IQ, or they have learning disabilities, or whatever it might be. That they're not able to access information through the interpreter. Regardless of that-I work with a lot of highly qualified interpreters who despite the fact that they're hearing are able to gesture. But I think that hearing people and deaf people think in different ways. You have to agree with me on this. They just approach the world in different ways than deaf people do. I've worked with-Darlene on my advisory board. I've worked with her for quite some time and how she signs something I think, uh-huh-I never would have thought of that. Or I see someone express themselves in a certain way and I use that knowledge for future use. I think it works in different ways. It doesn't mattered if you're a coda or an interpreter, minds do function differently. Ah-ha-I knew there was a coda in the room.

So whether you're a deaf person, two deaf people communicating with each other, it's just a different vibe. The second issue here as well is the linguistic issue. And the exchange of information. And with the CDI, and a deaf person who is more remedial, the relationship is more important. Big time. It's not just about the exchange of information. I'm deaf, nervous, I'm not sure what's going on. There's this big meeting with all these people. All of these big fancy professionals. What am I supposed to do. So the relationship is important. You don't necessarily feel a bond with the interpreter. You know who they are. But it's not like a person who's more of a grass roots person. The instant opening of dialogue is you're deaf too? Oh, you're with me. My ally. Another deaf person. There's the cultural aspect. I would say that's equally as important as the actual language that goes on. Here we have John who has some mild developmental delays. A pretty high functioning guy. But something is going on. I put nothing for Axis III.

This is an example here. His mother passed away from cancer about three years ago. He has no family support. He has school problems. He's often absent. His father's out of the picture. Currently he's in custody-state custody-since his mother died. So he's been a ward of the state for a number of years. He's in a lot of trouble. He's been out of sorts since his mother died. He has some behavior problems. And-which has led to some legal problems. So he's feeling kind of out of sorts. He's not necessarily functioning at a high enough cognitive level to understand all of these things that are happening. So basically you get the picture of who John is. These are some venues where John can be seen. There's the IEP for his schooling. Because of his behavior problems related to his depression and-he's involved with the division of child and family services or whatever you call it in your state. He's been adjudicated because of that. He has a legal guardian. The mother's gone. So there's a state attorney there acting as his guardian. The term in court in Utah is medical guardian. There are his behavioral problems, striking out, hurting other people. And then he has to go to court for these behavior problems.

So there's two different kinds of court-again he's a low functioning person. So these are some of the examples of some meetings you would see him in. Their team meetings. You have no family so we'll be your family. Tell us what you want John. What are your values-blah blah blah. So he has those team meetings. He's the only person in his family. He's a family of one because there's no one else on the scene. So this large team is asking what do you want? How can we help you. He has Vocational Rehabilitation evaluations to prepare him for is he going to post secondary education, what's his next step. So there's that kind of meeting. He has some job training at K mart. He's learning how to stock and that kind of thing. So he has to talk to his boss and various things like that. So as you can see, in a nutshell, John has a lot of places to be. Interacts with a lot of different people. And the question is, is he cognitively up to the task of understanding all of the different dynamics of all of these different situations? Remember he's a low functioning person, so I think the answer is no. Want to take over? Should I keep going? Okay.

So these are very adult oriented meetings he's going to. Things that will impact his future. Will he go to jail? Depending on how he answers his judge he may. When he answers questions about why he assaulted somebody for example. At his IEP meetings. Does he get a certificate or a diploma. He may think I'm going to be done with school in May but if the question is do you want a certificate of completion or a diploma, he may not understand the implications of those. He may understand the end point. Not that they're different outcome. He has to go to sex education classes to learn about relationships in order to be able to live in adult housing. There's what's called a relationship class. The point really is that it's sex Ed. Remember now John is remedial, he's low functioning. And if you have just a standard ASL interpreter there, most interpreters can put the information out, but they may not be able to meet his level of cognition and language. Especially if John starts to talk for himself, if he starts to sign what he's thinking about the interpreters may not pick up on it. Some may say you know, you know, and the interpreters may not know. The language may look very stilted-I'm sure you've met low functioning deaf people before and each of them has their-what word do I want to use? Their own idiosyncrasies. It depends on their background. The way they communicate. But it's unique to that individual person.

If you put an interpreter there trying to match his level they may be able to match that. But as soon as John starts talking by himself they may not pick up on everything because they can't read his mind. That's where and why you want to use a CDI. John knows this deaf person in the room with him is going to get him. The deaf person has a relationship with him by virtue of them both being deaf. The walls come down. Their hearts open. You're a deaf person, I'm a deaf person, we connect. There's just an understanding that's there between them. There's deaf culture, there's the community, the shared experiences. When somebody meets someone who is like them, they can make those connections and expand upon those common experiences in a way that hearing interpreters can't do. They don't have those common experiences. Does that make sense?

>>: I have a question for you. Frequently we call people "low functioning." Can you tell us a little more about what you mean by low functioning? Can you define that a little more? I think there are a lot of misconceptions out there. People are seen as low functioning meaning they can't do anything?

>>: That's a good point. That ties back to the first definitions I gave. What does low functioning mean and why are they. The why is the important thing. Is it something-

>>: Is it something in their brain. Well, I can understand low language but low functioning is a term I'm a little resistant to. Low language is a little more acceptable to me.

>>: Yeah, personally I hate the term low functioning. Because it doesn't explain anything. What does this person do? Give me a diagnosis. Why? It's like you asked-what's going on with this person. For example, let's go back to John. In John's situation he does have a problem with cognition. Many people would say, oh, he's low functioning but that's not his problem. The problem is that he has mild mental retardation that's causing it. This is John. We could say Jim, somebody else, and he could have a learning disability as his access to diagnosis. You know, hearing people have those issues as well. Not just deaf people. It could be an expressive language learning disability, for example. Can you-let's put out another example. Like a math disorder. Somebody who has a problem in calculating numbers. What is the problem exactly? It's much more specific. Low functioning is such a general term and it seems inappropriately applied. Again, we need to look at the diagnosis. In John's case-mild mental retardation. And then we can figure out where to go from there. Does that answer your question? I am he with you. I don't like using the term low functioning. Personally I hate it. That's why I was using the term remedial. But I asked a lot of people what it meant and they didn't know what it meant. It's not a term that's used in my area that much. So I want to give more specific. They have mild mental retardation, learning disability, or whatever. What is causing that. Yes?

>>: I think like many of us the term low functioning is a real blow to people's ego. I have a bachelor's degree, I'm an educated person and people say, you know, reading level is third grade level, I've struggled with those things and they are hard for me. But one way to define that is to say I'm grass roots. People who are grass roots, they sign and function in a different way. That's a way that people can feel good about themselves. Rather than labeling them low functioning. Interpreters sign more word order, a different language. So the needs are different. I use grass roots rather than low functioning.

>>: I love that. Good for you. That's it. That encapsulates what I'm talking about. That's the reason why we use CDI's. You said it. It's not because a person is less than-a lesser person. It's because they're grass roots. Because of their experiences. They may have some language limitations. They may not be mentally retarded. It may not be a cognitive limitation. But they may have some specific language needs. They might have some reversals. They may misspell things that the interpreters couldn't catch what they were talking about.

>>: Another way I say it is highly visual people.

>>: I was going to ask, like people who are learning disabled, sometimes are labeled low functioning but that really bothers me.

>>: I'm in agreement. I second everything both of you said. And that's why and when we want to use a CDI. Because as a deaf person, in all of these different meetings with all of these hearing professionals, the deaf person can go in and right away they have that connection and understand where they're coming from. Darlene does this all the time. I'm struggling in IEP meetings and fighting for what they want. They are-I'm saying deaf people can drive and they say no. They can't. But a deaf person goes in and has this interaction. There's a rapport there. They fit together. Our IEP has all sorts of guidelines. We're running out of time and I apologize for that. I need to respect our time limits here. So I'll say use a CDI, think about it, think about what the appropriate diagnosis is for the person you're working with and if you need to bring in a CDI. Remember it's not for the language mediation, it's also for the bond. That language that is developed. Because that CDI is deaf like me.

>>: There's one barrier for deaf people out there and it's taking the CDI test. I've talked to a lot of people who are really good and they take the test that they're expected to use the jargon used so they have to study to pass that test.

>>: Thank you for the comment. Thank you all for coming an making this a successful workshop. Applause to you for sitting-I'm sure your back sides are getting a little sore but I appreciate it. If you would like a copy of the power point presentation, give me your cards. Thank you. And everybody-could you please, --

>>: And everybody, if you would like, fill out your evaluation forms and leave them on the tables. I'll gather them up. Thank you very much.

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