Chapter 3 Services For People Who Are Deaf And Hard Of Hearing

54. This chapter introduces the national voluntary organisations who work with people who are deaf or hard of hearing. We also examine local authorities' performance in assessing need and in providing communication support, information and equipment services. Local authorities provide specific services and information about their own services, and the service of others, under the relevant legislation (see Annex 1). The 1995 Disability Discrimination Act requires that information is provided in accessible formats.

National Voluntary Organisations

55. National voluntary organisations for people who are deaf or hard of hearing are largely organised on a UK basis. These are the BDA, RNID and Hearing Concern. BDA and RNID have specific Scottish offices. BDA employs two staff in Scotland, a Youth and Community Officer and a part-time Community Advocacy Officer. The latter post is part of the Visible Voices (Scotland) project. BDA mainly identifies with those deaf people whose preferred language is sign language.

56. SAD operate on a Scotland wide basis. They have a small full-time staff group. They have developed a national registration scheme for people who are deaf or hard of hearing. SAD includes national and local organisations, both voluntary and statutory, in its membership. The Scottish Association of Workers with Deaf People has undertaken the task of drafting standards for work with people who are deaf or hard of hearing (note 16). The recently formed Forum of Providers of Social Work Services to Deaf People (Scotland) will also have a role to play in the future. SASLI also makes a vital contribution through its training of interpreters and provision of an interpreting service.

Assessing Need

57. Local authority specialist teams (or their agents) undertake a wide range of assessments:

• Contracted staff from voluntary organisations in Aberdeen and Moray are expected to offer assessments as part of a full social work service. They work jointly with other social workers on statutory work including child protection and mental health.

• East Ayrshire only expected their team to undertake simple assessments, e.g. for equipment. All other assessments are undertaken by other social work staff.

• In Argyll & Bute, Fife and Glasgow specialist teams are expected to undertake a range of assessments particularly in community care. Joint assessment with other social work professionals over child care and mental health issues is said to be common.

58. The files we examined indicated a variety of assessment practices similar to those offered to people with a visual impairment. These included:

• no assessment record - only a note of a visit and action taken;

• a standard front sheet, requiring boxes to be completed (mainly about equipment needs) with limited space for comment;

• a full community care assessment proforma for the person who was deaf or hard of hearing and including the needs of carers.

59. The absence of any written assessment was widespread amongst in-house providers. Staff may have carried out an assessment but there was no record of it. We did not find the information in these files that allowed us to conclude whether or not a fuller assessment was required. Nor was there any indication of the assessor having made that judgement.

60. When interviewed, specialist staff were alert to the social and emotional needs of many people who were deaf or hard of hearing. This awareness was not matched by what was recorded on files.

61. Whilst some case files had good quality assessments with care plans clearly linked to assessed needs, good quality assessment for people with complex needs was not widespread. For example:

An interview with one deaf person revealed that her needs were complex. Her marriage had ended and she was grieving over recent losses. She also needed equipment to help her in her role as carer to her father who was incontinent. Her case file had no assessment of her needs either as a deaf person or as a carer or of her father's needs.

62. A combination of qualified social workers and staff with good communication skills (note 17) is essential to good quality assessments for people who are deaf or hard of hearing. (Of the 27 local authorities which responded to our questionnaire, there were 19 in-house specialist teams, only 3 of which had qualified social workers in them.)

The evidence from our fieldwork supported this view:

• In Aberdeen, The Aberdeen and North East Society for the Deaf (ANEDS) has qualified social work staff, with specialist communication skills and knowledge as well as a Sign Language Interpreter (SLI). In Moray there is one unqualified social work assistant.

• Argyll & Bute have a qualified social worker able to undertake full assessments. He has British Sign Language (BSL) Stage 1 which limits his capacity to communicate with BSL users. Qualified interpreting is purchased from Glasgow City Council.

• In East Ayrshire social work assessments are undertaken by social work staff, some of whom have BSL Stage 1, with specialist support when required. East Ayrshire has 2 BSL interpreters (one full-time person, 2 job share).

• Fife has 2 qualified social workers and 3 social work assistants. Two of the staff have BSL Stage 2.

• In Glasgow the specialist teams are under strength and they are carrying vacancies. Decisions about who would undertake an assessment are made on a case-by-case basis. Glasgow specialist teams have full access to SLIs.

We recognise that the majority of hearing impaired people are not BSL users and may rely on other forms of communication.

63.Few social workers were confident in their knowledge of deafness and few had specialist communication skills. We found social workers involved in undertaking assessments in all areas of social work, to be either unaware or poorly informed of the support a specialist team might offer. Only Glasgow, Aberdeen and East Ayrshire provided guidance to their staff about the use of interpreters.

64. One submission (note 18) and both focus groups stated that social workers involved in undertaking assessments were insufficiently informed about the needs of both people who are deaf and those who are hard of hearing. This is said to lead to poor assessments and poor care planning.

65. None of the 6 authorities we visited provided written guidance on joint assessments by specialist teams and other social workers, suggesting that managers think this a low priority.

66. East Ayrshire has decided not to employ qualified social workers in their specialist sensory impairment team. It had planned provision of deaf awareness training to all relevant social work staff.

67. The incidence of hearing loss rises with age. According to RNID, 3 out of 4 people who experience a hearing loss are over the age of 60. RNID estimates that 60% of people over the age of 70, and 84% of those over 85 have a significant hearing loss. Our own survey reflects similar findings.

68. People with a hearing loss in our survey received the following from social work services (or their voluntary sector agents).

• assessment for specialist equipment ( 88%);

• advice on welfare benefits (33%);

• home care (13%);

• assistance with BSL interpreting (13%);

• a community alarm (9%).

69. Assessment and provision of equipment was by far the most commonly provided service. While 13% of the people in our survey have assistance with BSL interpreting we are concerned that no-one receives assistance with lipspeaking.

70. Deaf people in rural areas say they feel socially isolated. In Argyll & Bute and in Moray they described how they had little contact with other people who were deaf or hard of hearing, e.g. the nearest deaf club for people living in Oban is in Fort William.

The Services

71. There were a number of positive comments about services made by people in our survey.

• Fifty-five people (77%) said they could access services;

• Forty four people (59%) said the provision was timely whereas only sixteen people (21%) believed it to have been delayed;

• Forty-two people (55%) said that they felt the service to be professional and twenty-four people (31%) said it was what they expected;

• Thirty-nine people (51%) believed the provision to be co-ordinated;

72. The following chart illustrates the overall quality ratings for the six local authority areas inspection sites.

Figure 2. Overall Quality of Service Provision

The chart suggests that nearly 4 out of 5 people receiving services consider them to be of "good" or "good-medium" quality.

73. These quality ratings need to be treated with caution as our survey also provided evidence that expectations of the services may be low. With this caveat in mind, we found:

• services in Aberdeen and Argyll & Bute received a "good" rating from 80% or more of people who used their services;

• people who were deaf tended to rate the services they received lower than people who were hard of hearing.

Communication support

74. Communication support includes a wide range of human and technical aids to communication such as sign language, lipspeaking and other aids that support communication.

Sign language support

75. Of the 27 authorities who responded to our questionnaire 3 do not provide any sign language support. Of those who do, the most advanced recognised qualifications amongst in-house staff are:

• BSL Stage 1, three authorities;

• BSL Stage 2, five authorities;

• BSL Stage 3, four authorities;

• Registered SLIs, two authorities (note 19).

76. To undertake assessment and care planning roles with deaf people, specialist staff need fluency in BSL (i.e. BSL Stage 3). Eleven authorities lack ready access to such skills, including most rural and island communities.

77. In Argyll & Bute, Moray and Fife, social work staff with basic sign language skills appeared to be used extensively as interpreters in situations where higher skills will be commonly required. For example, we learned that social work staff qualified in BSL Stage 2 were interpreting at hospital clinics. Moray also accessed interpreters in Aberdeen North East Deaf Society.

78. Sign language interpreting services continue to evolve in Scotland, albeit slowly. In 1990 there were 25 SLIs overall. In 1997 there were 27 registered SLIs and 16 associate or trainee interpreters (note 20). The demand for interpreter services has consistently outstripped supply, and in Scotland there is some evidence that the demand is increasing with more children having used BSL at school in recent years.

79. Only a quarter of our responding authorities (note 21) had guidelines about the use of interpreters. Interpreters provided assistance for a wide range of activities, particularly in health education and court settings. Indeed the work of the interpreter is more likely to be outwith the social work setting rather than within it. Many SLIs operate on a freelance basis. Two of the authorities we inspected - East Ayrshire and Glasgow - employed interpreters, as does ANEDS, for work in Moray and Aberdeen. Argyll & Bute Council has unlimited access to SLIs, being a joint funder of the service with Glasgow.

80. The task of the interpreter needs to be distinguished from that of the social worker. The documentation in Glasgow illustrates this distinction:

"The SLI's interpreting task should not involve situations where intervention, participation or advocacy is required on behalf of the user."

The importance of maintaining this distinction has led to moves to increase the separation between interpreting and social work services. This separation is well established within Glasgow, but not always elsewhere.

81. There is a common expectation that interpreters employed by the social work department will intervene, or advocate on behalf of the people for whom they are interpreting. This breaches the code of conduct of registered SLIs. There is also an expectation, in some authorities, that specialist social workers with communication skills will undertake the work of an interpreter.

Lipreading and lipspeaking

82. Lipreading is a skill used by deaf and hard of hearing people in conjunction with hearing aids/residual hearing, which can be developed by attending lipreading classes taught by lipreading tutors.

83. Lipspeaking is a communication support service provided to lipreaders by a trained hearing person who, a few words behind the speaker, will devoice and use appropriate intonation, rhythm, phrasing and clarity to convey accurately the content and intent of the speaker's message.

84. Lipreading and lipspeaking support is important to an estimated 20,000 deafened people without BSL and to many people who are hard of hearing who require additional communication support. It has considerable benefits for older people who may use lipreading as their main means of communication when their hearing fails.

85. There are reportedly 24 trained lipspeakers in Scotland (note 22), of whom only 8 are regularly used. Of these only one is stated as being employed in a local authority. Twenty authorities claim that lipspeaking is provided directly or purchased.

86. The Scottish Sensory Centre runs a course for teachers of lipreading which is always over-subscribed. Adult education classes in lipreading are available but have not received widespread support or funding.

Other aids

87. The wish of one person using services that the "social work department had its own web site" may take time for some local authorities to achieve. A few authorities such as Moray already have one. New technology has introduced additional and alternative means of supporting communication, particularly for deafened and hard of hearing people who use English rather than BSL. Specialist teams in most larger authorities (and contracted agents) enable access to new equipment such as text phones and computerised speech/text facilities. However, only 13 authorities provide this sort of equipment, 9 purchasing it from voluntary organisations.

88. Communication is Your Responsibility (note 23) recently reviewed communication support throughout the UK. It preceded the 1995 Disability Discrimination Act which places the responsibility on authorities to provide accessible communication. In Scotland SASLI recently published a specific follow-up of this report and concluded that "many professionals are unfamiliar with the communication needs of people with a hearing loss. (note 24)

89. Communication support was appreciated by all those we interviewed who received it. However, the quality of the service was questioned with just over half describing it as reliable and only 35% saying communication support was available when required.

Information

90. The importance of providing information is best illustrated by one satisfied person:

"They gave us information - we did not realise how much help was available."

91. We asked people who used the services to assess the quality of the information they received:

• 22% said they received information while getting services;

• 14% said the information was provided at the right time;

• 5% had information before getting services.

92. For deaf people information needs to be in a sign language medium (video or CD ROM) rather than the English text form. Only 2 Scottish authorities, Glasgow and South Lanarkshire, produce signed videos at the present time.

93. The information needs of people with a visual impairment appeared to be consistently better addressed than the needs of those who are deaf or hard of hearing. This may reflect a reliance on oral rather than written communication in explaining the existence of services. A recent report (note 25) about the information needs of older people is a helpful document for authorities seeking to address this deficit.

Equipment

94. Equipment is important in maintaining safety in the home, sustaining communication and improving quality of life. This includes flashing lights, loop systems, personal listening aids and new technology such as vibrating pagers and fax machines.

95. Social workers and external agencies view the assessment for, and the provision of, equipment as a core function of the specialist teams. Specialist staff, including technical officers, view the provision of equipment as a possibly important introduction to a range of other services.

96. All authorities were asked to provide information about budgets for the provision of specialist equipment. Our analysis of responses suggests in cash terms there is considerable variation in these budgets across authorities. There are different charging policies, and people are encouraged to purchase their own equipment where their income and preferences allow.

97. Budgets can influence practice. East Ayrshire spoke of inheriting a backlog of referrals for equipment which would require budgetary consideration. Glasgow staff reported significant unmet need for want of funds. The length of waiting lists for assessment varied between authorities. In Fife the existing waiting list for assessment was exacerbated by a 30% rise in requests in 1997-98. Both Moray and Aberdeen (ANEDS staff) indicated that a request for assessment was normally met within 2 weeks.

98. The opportunities for people to try out equipment are limited. There are few resource centres addressing the needs of people with a hearing loss. Some of those that we did visit appeared to have a restricted range of equipment on display, and were less attractive than the centres established for people with a visual impairment.

Summary

• Over half the people surveyed have positive comments about the service they receive although these findings should be treated with caution.

• Social workers know little about deafness or how to communicate effectively with people who are deaf and hard of hearing. People who are deaf and hard of hearing are often referred to specialist staff for assessment and, whilst their sight loss needs are assessed, their wider needs may not always be considered. Relatively few people receiving specialist services are known to other social work staff.

• Joint working between specialist and other social work staff is neither systematic nor widespread.

• The communication support needs of people who are deafened or hard of hearing are not necessarily appreciated.

• Lipspeaking among social work staff is a rare skill. The provision of training for teachers of lipreading is oversubscribed and lipreading classes for deafened people or those who are hard of hearing is inadequate in many parts of Scotland.

• The direct employment of interpreters by social work departments (or their agents) needs review in the light of their heavy usage by other public services and the importance of maintaining the distinction between the roles of social workers and interpreters.

• The allocation of funding for specialist equipment is uneven and the opportunities to try out equipment in rural areas are limited.