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Position Paper on Specialized Services to Persons who are Deaf and Hard of Hearing
All levels of government, foundations and any potential funders are urged to promote excellence within a continuum of equitable, accessible and specialized services for all children, youth, adults and seniors who are culturally Deaf, deaf oral, deafened and hard of hearing.
Specialized services provide community supports for persons with a specific disability or illness that have common characteristics or unique support needs (i.e. common language or culture, treatment, information), requiring a common expertise and set of skills by the provider.
All levels of government have demonstrated acceptance that specialized services deliver quality care, are cost effective and reduce medical error. Government-supported specialized services currently exist for aboriginal groups, Chinese and Southeast Asian communities, children with complex needs, children with autism spectrum disorders, children and adults with developmental disorders as well as for people who are culturally Deaf, oral deaf, deafened and hard of hearing.
CHS’s specialized services include: Ontario Interpreting Services (OIS), CONNECT Mental Health and Addictions, General Support Services, Hearing Care Counselling, Employment Services, and Literacy.
In the continuum of service provision, specialized services fulfill a vital role that must be supported and accessible to the groups of individuals they are designed to serve.
Terms Key to Understanding the Issue
Specialized Services are services designed specifically for a targeted population provided by specially trained service providers. For this paper, the targeted population includes culturally Deaf people and people with hearing loss. CHS specialized services provide cultural affirmation and full accessibility, including on-site sign language (American Sign Language/Langue des signes québécoise ASL/LSQ), CART (Communication Access Realtime Translation) and communication access supports for Deaf and hard of hearing consumers.
Mainstream Services are services that are provided in the broader hearing community. To serve Deaf and hard of hearing clients, mainstream services require accessibility accommodations (sign language, CART and/or communication access supports) to be arranged and put in place in order to bridge the communication gap.
Cultural Affirmation: The optimal and appropriate environment for providing mental health services and other services such as employment consulting to persons who are culturally Deaf.
Visual/Auditory Communication Affirmation: Communication that is appropriate and affirming of culturally Deaf, hard of hearing and Deaf-blind people.
Qualified Professional Staff: Professional and frontline staff with the necessary cultural, linguistic, and clinical skills to work with distinct populations. Culture refers to concepts such as language, communication, relationships, roles, family, education, etc.
The Canadian Hearing Society (CHS) Position
Governments need to recognize the value and effectiveness of the work undertaken by specialized service agencies. Services delivered in an accessible environment by trained professionals who are experienced in the cultural, linguistic and historic reality of their clients have proven track records for providing the most successful outcomes for their clients.
The Canadian Hearing Society (CHS) is concerned that there is a growing trend to eliminate specialized services that will result in lasting consequences for people who are culturally Deaf or hard of hearing and perpetuate the systemic barriers these consumers face.
In response, the CHS has developed this policy position to clearly articulate the challenges, gaps and barriers, enumerate recommendations to address identified barriers and issues, and call on key stakeholders to adopt a collaborative and systemic approach to resolving this crisis across Canada.
The Rationale for CHS’s Position
Why specialized services are required:
- Unique language and communication needs: The needs of Deaf and hard of hearing people differ substantially from persons with other disabilities. To most people, ‘Deaf and hard of hearing’ simply refers to a person who cannot hear. However, total or partial (in) ability to hear has fundamental social and linguistic implications, and heavily influences relationships with others. For Deaf and hard of hearing persons, barriers are rarely about physical obstacles. Because of their unique communication needs, Deaf and hard of hearing people are distinct from all other persons with disabilities. While Deaf and hard of hearing persons may have effective modes of communication, they often do not have the opportunity for direct communication with others. This distinction is fundamental and differentiates Deaf and hard of hearing persons from others. Technology, hearing restoration and conservation also play a significant role in supporting persons relying on their use of auditory senses. As a result, assessments, interventions, service plans and outcomes offered by government and other mainstream service providers may be limited or inappropriate.
- Legal: In October 1997, the Supreme Court of Canada ruled that Deaf and hard of hearing Canadians are entitled, by Charter Right, to equal access and equal quality of services as their hearing counterparts. This ruling places a legal responsibility on all levels of government to ensure a comparable level of service is available to Deaf and hard of hearing individuals when accessing any government-supported program. This has a significant impact on how direct services are delivered in areas of health, education, employment, legal and social services. An inclusive model, entailing the hiring of interpreters, notetakers and captionists for all government services, is unrealistic and inadequate from both a cost and a staff availability point of view. In addition, legislation and policies on accountability and risk management must be factored in; specialized service providers mitigate these risk factors by providing appropriate services that mainstream service providers are unable to provide.
- Cost effectiveness and Efficiency: A great deal of time, energy and money has been spent trying to serve Deaf and hard of hearing persons within the inclusive model of mainstream service delivery. Specialized community services often play a critical role in system navigation and service coordination with existing general resources. CHS provides direct services in the areas of employment, ASL/ English or LSQ/French interpreting, mental health, general support services, hearing care counselling and accessibility supports. CHS aspires to provide appropriate, accessible case management services in each region of Ontario in an efficient and timely manner, thus saving the government large amounts of money. In addition, CHS provides an accessible service delivery model that addresses the communication differences and complex needs of the consumer. Furthermore, specialized services reduce wait times and lead to the outcomes consumers are entitled to.
- Limited number of trained professionals. The knowledge and skills required to work with this population are highly specialized and acquired through years of training, education and experience. Understanding the nature of hearing loss itself and the reality of living with a hearing loss in a hearing world are fundamental to meeting these consumers’ psychological, health and daily living needs. The isolation and systemic barriers experienced by individuals who are Deaf and hard of hearing, coupled with limited access to services, compound any other problems they may have. Simply bringing in an interpreter or attending a few workshops does not equip an integrated general service provider with the ability to address the needs of individuals who are Deaf and hard of hearing.
- Specialized services not a precedent. There are many examples of provincial specialized services: acquired brain-injury service, services for people with autism spectrum disorders, mobility services, services for people with eating disorders, services for people with developmental disorders. These specialized programs are geared to highly specialized consumer needs and are based on population numbers, geography and a concentration of expertise to ensure quality and successful service. There are numerous other specialized government initiatives: Infant Hearing Program, Long Term Care, Mental Health Services, Day Programs, Provincial Schools, French Language Health Services, Specialized Pediatric Services and Developmental Services.
CHS Recommendations for Collaborative and Coordinated Response
There is an urgent need for collaborative and targeted action to develop a coordinated response to the serious barriers and issues faced by Deaf and hard of hearing people. Comparison of the two models of service delivery highlights the benefits to Deaf and hard of hearing individuals when receiving equitable services to their hearing counterparts.
COMPARISON of SERVICE DELIVERY MODELS
2. Service providers require the service of professional sign language interpreters and Communication Access Realtime Translation (CART) captionists.
2. Specialized service providers can communicate effectively and directly with Deaf consumers and address their needs without possible language misinterpretation; and have access to and working relationship with professional CART captionists
3. Service delivery and working environment is not accessible for Deaf and hard of hearing consumers due to lack of generic office equipment e.g., TTY. Next Talk System (NTS) and language barriers.
3. Service delivery and working environment is accessible for Deaf and hard of hearing consumers by staff who communicate using sign language, use accessible office equipment (e.g. NTS) along with CART captionists when required
4. Often do not provide “one-stop-shopping” service. This creates poor and ineffective outcomes and makes case management services inefficient.
4. Service provider and consumer can work together as a “team” to provide comprehensive coordinated services in a cost effective manner. This will also provide appropriate, accessible case management service delivery.
5. Coordinating and confirming professional sign language interpreters and CART captionists is time consuming, resulting in a delay of effective service to Deaf and hard of hearing consumers.
5. Service providers with a proficient skill level of sign language can provide service promptly without delay to the consumer. Professional CART captionists are more readily available.
6. Lack of access to information and knowledge of appropriate agencies will result in inappropriate referrals for Deaf and hard of hearing consumers thus causing delays in service delivery.
6. Service providers are well connected to local integrated agencies and are familiar with their mandates, level of accessibility and quality of service. Therefore service providers can ensure appropriate and efficient referrals for Deaf and hard of hearing consumers as required.
7. Deaf and hard of hearing consumers may feel oppressed or powerless in an environment that lacks access.
7. Deaf and hard of hearing consumers feel their language and accessibility preferences are accepted and thus develop a more positive self-identity and greater opportunity for success.
8. Lack of access, use of sign language and captioning results in an awkward, unexpressive communication flow.
8. Use of sign language and CART captionists between service provider and consumer provides an expressive free form of communication and flow of information/ideas.
9. Creates a pattern of ineffective and inefficient services – e.g. different services at different places that costs travel time and communication access.
9. Service is efficient and cost effective. e.g. one stop service - one place, many services; full access.
10.Excessive cost to secure professional sign language interpreters (e.g. Caseworker with 20 Deaf consumers would need to purchase approximately 60 hours of interpreting services)
10. Cost of using professional sign language interpreters is kept to a minimum because staff are proficient in communication alternatives and in signed languages.
11.Due to the severe shortage of professional sign language interpreters who are readily available on a daily basis, it is almost impossible to service a high caseload of Deaf consumers
11. Because specialized service providers use sign language, services can be provided effectively and in a timely manner to Deaf consumers without disruption of service delivery, if waiting for an Interpreter.
CHS recommends the following actions:
- Offer a central point of access for this group of consumers with complex language and communication needs; (i.e., the most effective “where and how” would need to be determined)
- Educate the public and consumers about specialized service agencies such as those offered by CHS;
- Educate mainstream service providers to refer these consumers to specialized service agencies;
- Coordinate and ensure effective navigation of a wide range of services that are person-centred
- Ensure consumers are served appropriately, efficiently and effectively;
- Meet the language and communication needs and provide the access supports required by Deaf and hard of hearing people in an environment that is knowledgeable and empathetic;
- Work with government to effectively manage specialized support services such as the provision of sign language interpreters, communication access realtime translation (CART), and the use of assistive devices for creating an accessible environment.
Provincial specialized service agencies such as CHS already collaborate with a network of multi-service providers including Western Institute for Deaf and Hard of Hearing in B.C.; Saskatchewan Deaf and Hard of Hearing Services; Nova Scotia Deaf and Hard of Hearing Services; and other provincial specialized service providers. This network is well-established and ready to partner with other service providers throughout the rest of Canada to ensure their services are capable of managing the complex language and communication needs of our consumers in a person-centred model.
Existing legislation, significant legal decisions, and independent research reports, Home and Community Support Services for Persons with a Physical Disability in Ontario: Wait Lists and Wait Times Descriptions, September, 2012; Final Report to the Provincial Liaison Committee for Persons with a Physical Disability (PLCPPD) and the Research Unit, Planning, Research and Analysis Branch, Ontario Ministry of Health and Long-Term Care (MOHLTC) Prepared by Toronto Rehabilitation Institute – University Health Network and National Association of the Deaf Position Statement on Mental Health Services, 2003 support CHS’s position. In brief, they are as follows:
The Canadian Charter of Rights and Freedoms : The Charter is a bill of rights entrenched in the Constitution of Canada. The Charter protects the political and civil rights of all Canadians, and supersedes all federal and provincial legislation including human rights codes. The Charter is explicit in its provision for sign language interpreting services during any proceeding in which Deaf Canadians are involved (see Section 14 and 15(1).)
Canadian Association of the Deaf, et al. v. Her Majesty the Queen : This most recent Federal Court of Canada decision requires that all Federal Government programs, offices and services provide sign language interpreting services "upon request." The ruling makes explicit the right of access to government.
United Nations Convention on the Rights of Persons with Disabilities  Canada and 151 other Member States and the European Community signed and ratified this landmark new convention at the United Nations. Canada ratified this treaty in March 2010. The treaty aims to eradicate discrimination against persons with disabilities in all areas of life including employment, education, health services, transportation and access to justice. The Convention requires States Parties to acknowledge sign language, promote the linguistic identity of the Deaf community, and provide sign language interpreters among other issues relating to people who are Deaf.