Journal of Vocational Rehabilitation, 7(1996) 125-128
Using the Intervener Model with Adults Who are Deaf-Blind
Edwin Hammer* , Richard Carlson
*Texas Tech School of Medicine, Dept. of Pediatrics, 1400 Wallace Blvd. Amarillo, TX 79106
Michigan Commission for the Blind, 201 N. Washington Sq., Box 30015, Lansing, MI 48909
Abstract: This article presents basic information on the success generated by the Michigan Commission for the Blind when using the Intervener Model to provide support for persons who are deaf-blind.
Keywords: Deaf-blind, intervener model, Michigan commission, Functional Skills Screening Inventory, FSSI, transition, community-based services, long term follow up
Delivery systems continue to evolve. At one time, the residential institution was the center of service delivery for persons who are deaf-blind. Over the years there has been a gradual shift toward community-based services for adults who are deaf-blind. For some time community-based services seemed to concentrate on group homes in a effort to provide a 24-hour services as well as being more associated with community activities. To some, group homes are simply mini-institutions: de-personalized, expensive, isolated, regimented, and bureaucratic. To others, a group home is the best that is available: trained staff, signing environment, constant care, and economic in administration. The problem, however, seems to be that delivery of services to adults who are deaf-blind need to be in natural settings, with social support coming from many sources (family, friends, community representatives), and with approximation of the usual lifestyle of the family rather than an artificial environment. How can this be done within the available resources and with the history of social support for persons who are deaf-blind?
In 1991 the Michigan Commission for the Blind attempted to address this issue through community-based support personnel. These individuals are called interveners, based upon a model from Canada that advocates for community-based services in natural settings. Programs using interveners have been utilized in Florida as well as in Utah. The Michigan intervener program attempts to use family and friends of adults who are deaf-blind within a formal setting of community mental health services. The intervener model offers potential for using community resources to provide support to the adult who is deaf-blind. The model uses persons who have specific skills in working with adults who are deaf-blind (i.e. sign language, home signs of the client, and understanding of communication imbedded in behaviors). The persons serving as interveners live in the same community as the adult who is deaf-blind and may be neighbors, college students, interpreters for persons who are deaf, or interested citizens. The goal of the intervener program is to "make the system work" meaning that the intervener pulls together diverse sources of services to meet the unique needs of the person who is deaf-blind. The intervener is defined as the extension of the eyes and ears of the adult who is deaf-blind. However the intervener is not an interpreter. The intervener links the individuals who are deaf-blind to the community and the people in the community. The intervener is there to supplement existing services, not to supplant these services.
In the 1990s the populations born with Congenital Rubella Syndrome entered into adult services. In Michigan the schools retain responsibility for persons who are deaf-blind until age 26 years. Thus the need for services to adults coming out of school settings increased dramatically in the last decade of the century. Also, the de-institutionalization movement in Michigan increased the numbers of persons who are deaf-blind and in need of community-based services. The available services specifically for individuals who are deaf-blind were limited. The Helen Keller National Center offers 40 slots for all 50 states on a yearly basis. The Michigan Commission for the Blind Training Center had openings for adults who are deaf-blind but did not have staff well trained in assessment and programming for persons who are congenitally deaf-blind. The alternative was to build individualized programs within the adult’s home community using local resources and available staff.
Another factor led to the use of interveners in Michigan. The state plan for lifetime services to persons who are severely disabled calls for life-long services to be provided through community mental health centers (CMH). The CMHs in Michigan are the ‘safety net’ of the service delivery system. If no other service delivery system assumes responsibility or is unsuccessful in working with a group of citizens who are developmentally disabled, then the CMH must provide comprehensive services. The desire of the Michigan Commission for the Blind and the request for assistance by components of the CMH system set the stage for a mutual effort to address disabilities: adults who are congenitally deaf-blind.
Thirteen adults who are deaf-blind and have additional problems were selected to participate in the community-based intervener project of the Michigan Commission for the Blind and the CMHs in Michigan. A pre-test of abilities was collected as baseline on each individual. Periodic monitoring of the status of the individual who is deaf-blind was also conducted. The last assessment was used as a post-test to describe what has happened to this group over the four year period. The instrument used to assess and monitor the adults who are congenitally deaf-blind is the Functional Skills Screening Inventory (FSSI), a behavioral checklist that was specifically designed and normed on persons who are deaf-blind (see Boros Tenth Mental Measurement Handbook for a review of the test). The specific questions monitoring with these data included:
1. Do functional skills increase over time when an adult who
is deaf-blind is in an
2. What specific daily living skills change when an adult who
is dead-blind enters the local
3. Are there deficits in living skills in adults who are deaf-blind
that continue to decrease
There are nine scores reported on the FSSI. These include: 1) Basic Skills and Concepts, 2) Communication, 3) Personal Care, 4) Homemaking, 5) Work Skills and Concepts, 6) Community Living, 7) Social Awareness, and 8) Problem Behaviors. There is also a Total FSSI composite score of all the 8 components. The Total FSSI scores were compared from the pre-test to the post-test. These tests were administered over a four year period of time. Respondents were family members, foster parents, group home staff, or interveners. The sample included 13 persons who were deaf-blind due to Congenital Rubella Syndrome. The age range of the sample was from 24 years to 36 years (mean 28 years) at the time the person entered the study.
When the Total FSSI pre-test results were compared to the Total FSSI post-test scores, there was a significant change in scores as computed using a t-test. Pre-test Total FSSI mean scores were 440.53 compared to Total FSSI post-test mean scores of 569.15. This yields a significant change at the 0.001 level in the overall change as measured by the Functional Skills Screening Inventory.
The FSSI scores were further analyzed. The Basic Skills and Concepts subscale is delineated into further categories of basic motor behaviors (standing, walking, grasping), sensory discrimination (with allowances for visual and hearing losses), the ability to use objects in daily living (using utensils, grouping using own categories), and spatial relations and mobility (movement in space, understanding positional concepts). On this subscale, the 13 participants increased their functional skills in a significant manner (P = 0.001) over the 4 years of the study.
Participants in the study also improved communication skills. This subscale of the FSSI targets communicative behavior in terms of receptive and expressive skills with particular emphasis on lower functional communication. On this measure the change in communicative behaviors for the study group was significantly increased (P = 0.002) over the time span of the study.
On the subscale for Personal Care, the FSSI explores eating skills, dressing skills, body care, health care, and the use of leisure time in persons who are deaf-blind. The group in Michigan improved significantly (P= 0.001) in their personal care over time when entering community-based services.
The Homemaking Scale of the FSSI reviews functional skills in cleaning and food preparation. The 13 subjects studied had a positive change in homemaking skills (P = 0.005) in the 4 year time frame.
Work Skills and Concepts of the FSSI assesses work awareness
in the client, social skills in the work setting, specific work
skills, and work habits. This level of assessment is appropriate
for assessing self-management in occupation of time, supportive
employment progress (job-share, job coaching, team work assignments),
as well as competitive work in the community. On this measure, the
adults who are deaf-blind had a positive change ( P = 0.028) over
The FSSI subscale on Community Living reviews the functional skills of the client in terms of reading or writing at a survival level, knowledge of numbers and quantities, the use of money in the community, and concepts of time as used in daily living. On this measure, participants in the study had a positive change (P = 0.021).
Adults who are deaf-blind and returning to a community-based program using interveners increased social awareness in the time period studied. The positive change was significant at the 0.001 level for exhibiting skills in controlling their own behavior, initiating interactions with others, showing respect and interest in others, as well as developing friendships.
In terms of the Problem Behaviors scale of the FSSI, persons in the study did not change significantly in their behaviors that are barriers to participation in services. However, it must be noted that problem behaviors did not increase during this time of measurement using the Functional Skills Screening Inventory.
The use of interveners to assist persons who are deaf-blind in their return to community-based adult living and working settings seems to offer several advantages. The intervener is a local person who is trained in communication skills and in the unique characteristics of persons who are deaf-blind. The intervener is available to go into group homes, family homes, or residential programs to assist in the transition of the adult who is deaf-blind from one setting to another. The intervener is available to develop networks of helpers within the family and neighborhood so that services are maintained to the adult who is deaf-blind. This form of companionship seems to impact on the daily life of the person who is deaf-blind by building support services within the natural environment. Further, these same interveners can be converted to job coaches as the person who is deaf-blind enters the vocational arenas.
In answer to the 3 questions asked in this study, it does seem that functional skills increase over time when an adult who is deaf-blind is in an environment that recognizes communication needs, self-direction, and interpersonal skills. This is reflected in the significant increase in overall FSSI scores over a 4 year period. The persons in the study group increased their eating behaviors, their dressing skills, skills in body care, and use of leisure time. Along with these positive changes there were improved communication skills. There were no deficits in behaviors that continued to decrease in this population as they moved into community-based settings. Even with this small sample, the positive aspects of an intervener program cannot be ignored. It is also worthwhile to note that costs for intervener services are approximately 1/3 of the cost of maintaining a person who is deaf-blind in a group home or residential setting.
Results of this small sample indicates a need for the field to explore alternate programming for persons who are deaf-blind. The interveners in Michigan had a variety of backgrounds and experiences but the common thread among them was that they lived in or near the community they served. They were not professionals trained in services to persons who were deaf-blind but were provided training to enhance their service abilities. Moreover, these interveners were able to evoke a support network among neighbors, friends, and family members that maintained services. The intervener model is not the single answer to the problem of life-time services to persons who are deaf-blind but it does add one more piece of the puzzle to the picture of developing delivery options while building the delivery system.
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