Communications Assistants' Training Outline

Below is the training outline that I used to train Relay Operators (ROs) in Australia in 2001. This outline covers 1/3 of what ROs need to know before they can effectively assist STS users. In the US, the name for ROs is Communications Assistants (CAs). All STS CAS have previous experience as CAs for the TTY relay (for people who are deaf). Thus, STS CA trainees already know TTY relay procedures. The STS procedures are essentially the same as the TTY relay procedures except that the TTY Relay CAs communicate with deaf users by TTY, while STS CAs communicate with STS users by voice. There are three traditional parts of STS CA training. Some of the phone companies may include additional elements in their training but are keeping that information proprietary.

STS CA trainees receive basic TTY relay protocol training as part of their training to be TTY relay CAs. This training includes knowledge of company policy concerning. Each of the main providers of STS in the US (Sprint, MCI, AT&T and Hamilton) has its own company policies to teach CAs.

My training outline below describes what STS CAS needs to know about the speech disabled population. This is the part of the training that I developed.

The final phase of STS CA training is on the job experience. By simply re-voicing (repeating what the STS users are saying) STS calls for STS users, CAs learn much of what they need to know. This phase is probably the most important one as it teaches CAs what the users really want them to do.

Bob Segalman, Ph.D.

Training Of Speech-to-Speech Relay Operators Outline of Training Package

General purpose Speech-to-Speech (STS) allows people with speech disabilities to use their own voices to place calls with the assistance of a relay operator. The person with the speech disability will not be using a TTY.

Time Frames: Speech-to-Speech is available 24 hours a day in the USA and Australia. Relay should provide telephone access for everyone.

The speech disabled person will speak directly to the relay operator. The relay operator will repeat their words after each phrase or short sentence. Once the speech disabled person has said "Go ahead" and the relay operator has repeated what the speech disabled person has said, the relay operator will tell the other customer to "Go ahead".

Voice inflection that is used in typical relay calls will be important for making this type of call sound natural.

1. Characteristics of Speech-to-Speech Customers.
   1. Causes of Speech Disabilities
      It is very important for us to understand our customer. Speech disabilities occur due to medical reasons.
   2. 1. Cerebral Palsy
      2. Brain injury due to an accident
      3. Laranyx removed due to cancer
      4. Multiple Sclerosis, Muscular Dystrophy, Stuttering, Spasmodic Dysphonia, ALS, Parkinson's Disease, etc.

So far, most users have Cerebral Palsy. Speech disabilities can occur anytime in a person's life.

The degree of speech disability does not reflect a person intelligence. There is an analogy here to the American deaf population as many very intelligent deaf people have limited written English as their native language is American Sign Language. Imagine the frustration of a person who wants to express him/herself, yet due to a speech disability has trouble being understood by others. The use of a telephone can compound these frustrations. People with speech disabilities who try to make standard telephone calls experience people hanging up on them, yelling at them to stop making prank calls, etc. At the start of an STS call, the RO sets up the call for the customer and explains to the called person the service. By explaining the service, the RO is a vital link in establishing communication.

Varying speech patterns

1. Most customers may use their own voice without any assistive devices.
2. Customers may use a variety of telephones to place the call:
   1. speaker phone
   2. amplified phone
   3. standard telephone
3. Synthetic speech--some customers with speech disabilities may program the words they want to say into a computer. The speech is generated by the user with a speech disability typing on a special keyboard to produce words and sentences. Depending on the type of device used, the speech may sound computerized. One trait of this type of communication is slow speed. It may take several minutes to compose a sentence.
   
   
   1. Types of Calls -- What types of calls will the customers with speech disabilities make?
      
      1. To get a ride
      2. To order food
      3. For personal business (i.e. banks)
      4. To people who aren't familiar with their speech patterns
      5. Business calls
      6. Any kind of call any person would make
      1. Requisite Skills Of ROs
      
      Listening skills are very important to fully understand what the person with a speech disability is talking about.
      
      2. Adjust the volume control of your headset to the necessary level for each customer.
      3. Tune out activity that may be taking place around you.
      If information is given about the topic of the conversation, listen for key words that will assist you in understanding the full sentence.
      
      
   2. Patience
      Patience is a key part of your role as a relay operator for speech to speech. Handling each call to the best of your ability is key to your success. You should be prepared to experience:
      1. Long pauses
      2. Asking the customer to repeat
      3. Asking the customer for clarification
      4. Dealing with frustrations from voice/hearing customer
      5. Possible longer call lengths
   These aspects are inherent to STS calls and should not cause you anxiety in processing the call. Remembering the needs of your customer and the service you are providing will help keep you focused. Do not feel a need to rush communication or feel inadequate if you cannot understand the speech disabled customer's words on the first or second try.
   
   
   3. Script for ROs
   1. Prompting Users
      The RO should prompt users leaving a message if they forget to leave their name and telephone number. RO should know, however, that many users will often omit their name and telephone number if they know that the person who they are calling only receives Speech-to-Speech calls from them. That is, once the person for whom the message is left hears that it is a Speech-to-Speech call, they will know who is calling. The prompting phrase must allow for such situations, such as: "Did you purposely omit your name and telephone number from that message?"
   2. What to do when the users' speech is not understandable
      Never give up on the consumer, just keep asking them to repeat and to spell phonetically. Look for the phonetic alphabet on the STS web site (www.speectospeech.org).
   3. RO Greetings when the STS call is answered:
      1. Greeting with optional "go ahead" and flexibility for able-bodied caller to fill in when RO misses a word. The person who is calling you can hear and has a speech disability. They will speak directly to you and I will repeat what they say. When you hear "go ahead” or a very long pause, please respond directly to your caller. Please say "go ahead " or pause when you finish speaking. If you understand a word or phrase that I do not, feel free to fill in. In a moment your call will begin.
      2. Here is a greeting for a caller who have never received a Speech-to-Speech call before:
         The person who is calling you can hear and has a speech disability. They will speak directly to you and I will repeat what they say. When you hear "go ahead," please respond directly to your caller. Please say "go ahead" when you are through speaking. In a moment your call will begin.
   4. Language to verify that caller has received a Speech-to-Speech call before RO asks:
      "Have you ever received a Speech-to-Speech call before?"
      If response is yes but tentative, the operator says: "Speech-to-Speech is different from a TTY relay call for someone who is deaf or hard-of-hearing. Your caller has a speech disability, but can hear...."
   5. Language to limit chit chat while on hold
      
      During each session on hold the operator has three possible reactions to chitchat:
      Operator's Response to first chitchat attempt -
      "We're on hold now."
      
      Response to second chitchat attempt -
      "We're continuing to hold."
      
      Response to third chitchat attempt -
      "While we're on hold I am not allowed to talk with callers." RO may repeat this last response as often as necessary.
   6. How to resolve problems during a call:
      If you have trouble hearing the caller, you can remind the caller to speak directly into the telephone.
      
      If you have trouble understanding a number you can have the caller tap the appropriate number of times.
      
      Part of your job is to keep each caller from interrupting the other one. They both must say "Go Ahead" after talking.
      
      Don't let able-bodied callers finish sentences for speech disabled callers. Finishing sentences is demeaning.
      
      All operators must be patient people with acute hearing.
      
      The operators' room should be quite and the partitions between the operators′ stalls should be sound proof enough so that operators can concentrate intensely on hearing the caller's speech.
      
      Operators participating in STS should be volunteers.
      Speech disabled users don't need to say "s" after the telephone number that they're calling as it's clear that they are speech disabled.
      
      Keep a formal operator-caller relationship at all times and avoid any informality that could be misinterpreted by the speech disabled caller as patronizing.
      
      Adult callers must be treated as mature adults at all times regardless of their behavior.
      
      At the start of the call the operator announces that she will re-voice throughout the call unless the parties ask her to stop. Some people with speech disabilities can be clearly understood if allowed to speak uninterrupted; they don't need RO to voice for them. They just need the other party not to interrupt them.
   7. ROs To Experience Caller Frustration
      
      To give ROs a better knowledge of the experience of STS users, the last section of the training consists of each RO coming to the front of the room and filling his/her mouth with peanut butter and crackers. The RO then places an STS call usually to a family member. The RO explains to the family member what is going on without removing the peanut butter and crackers from his/her mouth.
      
      After the call ends, the RO describes her/his feelings during the call to the audience.

   

    

   Social Security Disability Benefits and Communication Disorders

    

   Humans use verbal and non-verbal communication each day to interact, learn, and express emotion. When a person’s ability to communicate is impaired, he or she may face a unique set of challenges.  While it is possible to overcome these challenges, living with a communication disorder requires a certain level of support. This may include therapy, assistive devices, and medical intervention.

   Unfortunately, living with a communication disorder can be costly—even more so if you are unable to work or earn a living. Fortunately, individuals who have communication disorders may be eligible to receive financial assistance in the form of Social Security Disability benefits.

   The following article is intended to present readers with an overview of Social Security Disability benefits and to provide the background information needed to prepare for the application process.

   Disability Defined

   Before an applicant can qualify for disability benefits, he or she must first meet the official definition of “disability” as provided by the Social Security Administration (SSA). This definition is split into two parts—one for children and once for adults.

   The adult definition of disability is based around a person’s ability to maintain employment. Consider the following questions:

   • Are you able to do the work you did prior to becoming disabled?  If you are able to work, and earn substantial income (more than $1,040 per month in 2013), you are not considered to be disabled.

    

   • Do you have a mental or physical condition that prevents you from learning or adjusting to other types of work? If you cannot do the type of work you did prior to becoming disabled, but are capable of doing different work, you will not be considered disabled.
   • Is your condition—or conditions—expected to last at least one year or result in death? If your condition hasn’t lasted or is not expected to last a minimum of 12 months, the SSA will not consider you to be disabled.

    

   For children, the SSA’s definition of disability is based on the ability to function at an age-appropriate level. To determine whether or not your child is disabled, consider the following:

   • Does your child have a job considered to be substantial work? If so, the SSA will not consider him or her to be disabled.

    

   • Does your child have a serious mental or physical condition that seriously limits his or her abilities? If no, your child will not be considered disabled.
   • Is your child’s condition or conditions expected to last at least one year? If not, your child is not disabled according to the SSA’s official definition.

    

   Technical Eligibility
   Adults and children who meet the SSA’s definition of disability may qualify for one of two disability benefit programs.

   The first type of disability benefit is Social Security Disability Insurance (SSDI). SSDI is typically offered to disabled adults who have employment history and who have paid Social Security taxes.  Children do not typically qualify for SSDI due to lack of employment history. For more information about the technical eligibility requirements for SSDI, visit the following page: http://www.disability-benefits-help.org/glossary/social-security-disability-insurance-ssdi.

   The second type of disability benefit is Supplemental Security Income (SSI). SSI is a type of welfare program designed for disabled individuals of all ages who earn very little income. SSI is a good fit for both children and adults. Eligibility for SSI is based solely on a person’s income and financial assets.  In the case of a child who is not responsible for his or her own income, the entire household’s income will be evaluated.  Learn more about SSI technical eligibility, here: http://www.socialsecurity.gov/ssi/text-eligibility-ussi.htm.

   In certain circumstances, applicants may be eligible to receive both types of benefits.

   Adult Medical Eligibility

   After meeting the SSA’s definition of disability and the technical eligibility criteria—the SSA will evaluate your health condition to determine if you meet certain medical requirements.  To do so, they will consult a publication commonly referred to as the Blue Book. The Blue Book is the SSA’s official guide of potentially disabling conditions and medical criteria.  As with the definition of disability, the Blue Book is split into two sections—one for adults and one for children.

   If your symptoms and the progression of your disability match those listed under a condition in the Blue Book, you may be eligible to receive disability benefits.  Adult speech disorders are covered under the following Blue Book listing:

   Section 2.09—Loss of Speech: Under this listing applicants will qualify if they suffer from lack of speech due to any cause—characterized by the inability to produce any speech that can be heard, understood, or sustained.

   If an adult applicant does not meet this listing but suffers from a communication disorder, he or she may qualify under a separate listing related to the cause of their speech disorder or related to the affected body system.  These may include the following listings:

   • Section 2.10/2.11—Hearing Loss
   • Section 11.04—Central Nervous Vascular Accident (Stroke)
   • Section 11.10—Amyotrophic Lateral Sclerosis
   • Section 11.13—Muscular Dystrophy
   • Section 11.17—Degenerative Diseases (Huntington’s Disease)
   • Section 11.18—Cerebral Trauma (Traumatic Brain Injury)
   • Section 12.01—Autistic Disorders and other Pervasive Developmental Disorders
   • Section 12.02—Organic Mental Disorders
   • Section 12.05—Intellectual Disability
   • Section 13.00—Malignant Neoplastic Diseases (Cancer)

    

   Access all adult Blue Book listings, here: http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

   Childhood Medical Eligibility

   Childhood speech disorders are covered under the following Blue Book listing:

   Section 111.09—Communication Impairment (Associated with Documented Neurological Disorder): To qualify under this listing child applicants must demonstrate the following:

   • A documented speech deficit which significantly affects the clarity and content of the speech; or
   • A documented comprehension deficit resulting in ineffective verbal communication for age; or
   • A documented hearing impairment.

    

   As with an adult applicant, children who do not meet this listing may qualify under a separate listing related to the root of their impairment. These may include the following Blue Book listings:

   • Section 102.10/102.11—Hearing Loss
   • Section 112.05—Intellectual Disability
   • Section 111.07—Cerebral Palsy
   • Section 112.10—Autistic Disorders and other Pervasive Developmental Disorders

    

   Access all childhood Blue Book listings, here: http://www.ssa.gov/disability/professionals/bluebook/ChildhoodListings.htm

   Medical Vocational Allowance

   Applicants who do not meet any Blue Book listing may still be able to qualify for disability benefits under something called a “medical vocational allowance”. Essentially, for adults, this means that the SSA will evaluate your age, your job training, your physical capabilities, and your mental capabilities to determine whether or not you qualify.

   Children who do not meet a Blue Book listing will be evaluated based on their functional limitations.

   Social Security Disability Application Process

   Prior to beginning the Social Security Disability application process, it is important that you collect the necessary documentation to support your claim. This should include extensive medical, financial, and employment records.

   If you are an adult applicant, you can choose to fill out the necessary forms on the SSA’s website or in person at your local Social Security office. If you are the parent of a child applicant, you will have to fill out several forms and attend a mandatory disability interview.  Although a portion of the child application paperwork can be completed online, many parents choose to complete both in person during their scheduled interview.
   After submitting your application for disability benefits, you may wait several months before receiving a decision.  It is important that you prepare yourself to face the possibility of a denial. If this happens, you will have 60 days in which to appeal the SSA’s decision.  You should not give up at this stage because many more applicants are approved during the appeals process than during the initial application process.

   For more information visit Social Security Disability Help (http://www.disability-benefits-help.org/blog) or contact Molly Clarke at mac@ssd-help.org.

   Molly Clarke is a writer for the Social Security Disability Help blog where she works to promote disability awareness and assist individuals throughout the Social Security Disability application process.