Providing Health Care for People with Disabilities: Competency Planning Checklists

Communication Access

DEFINITIONS

Assistive Listening Devices: Help participants who are hard of hearing by making the voice or sound louder. They reduce background noise, make the voice clearer and easier to understand.

Audio Visual-descriptive Narration (audio description): Film and video description (also called audio description) makes television and other visual media accessible to people who have difficulty seeing. Narrative descriptions of a program’s key visual elements such as actions, graphics and scene changes are recorded and carefully blended into natural pauses in the program soundtrack, creating an additional mixed audio track that is broadcast or shown simultaneously with the program.ⁱ

Captioned Films and Videos include spoken words that appear in text on the bottom of the screen, as in subtitles. "Open" captions can be seen by everyone while "closed" captions are visible only when activated by the viewer.

Communication Access: Means providing content in ways that are understandable and useable by people with reduced or no ability to: See, hear, read, learn, move, speak, remember and understand.

Companions: A person who is “legally allowed to make health care decisions on behalf of the participant, or chosen by the participant to communicate with health care providers about the participant, the participant’s needs, condition, history, or symptoms, or is authorized to help the participant act on information or instruction.” ⁱ

Computer Assisted Real Time Transcription (CART): A service similar to court reporting in which a transcriber types what is being said into a computer that projects the words onto a screen. This service, which can be provided on-site or remotely, is particularly useful for people who are deaf or have hearing loss but do not use sign language.

Print Materials: Include but are not limited to, audio recordings, Braille, electronic text/disk/CD-ROM/flash or thumb drive, large print

Signed Films and Videos: include spoken words translated to sign language using live on-screen interpretation.

Speech-to-Speech: Relay services that provide Communications Assistants (CAs)[1] for people with speech disabilities, including those who use speech generating devices, who have difficulty being understood on the phone. CAs have strong language recognition skills and are trained participants familiar with many different speech patterns. The CA makes the call and repeats the words exactly.

Telecommunication and Phone: Includes but are not limited to, e-mail, instant messaging, short message service, TTY.

Telecommunications Relay Services: A free nationwide service, reached by calling 7-1-1, uses communications assistants (also called CAs or relay operators) who serve as intermediaries between people who have hearing or speech disabilities who use a text telephone (TTY) or text messaging and people who use standard voice telephones. The communications assistant tells the telephone user what the other party is typing and types to tell the other party what the telephone user is saying. TRS also provides speech-to-speech transliteration for callers who have speech disabilities.

Video relay service (VRS): A free, subscriber-based service for people who use sign language and have videophones, smart phones, or computers with video communication capabilities. For outgoing calls, the subscriber contacts the VRS interpreter, who places the call and serves as an intermediary between the subscriber and a person who uses a standard voice telephone. The interpreter tells the telephone user what the subscriber is signing and signs to the subscriber what the telephone user is saying.

Video remote interpreting (VRI): A fee-based service that uses video conferencing technology to access an off-site interpreter to provide real-time sign language or oral interpreting services for conversations between hearing people and people who are deaf or have hearing loss. The new regulations give covered entities the choice of using VRI or on-site interpreters in situations where either would be effective. VRI can be especially useful in rural areas where on-site interpreters may be difficult to obtain. Additionally, there may be some cost advantages in using VRI in certain circumstances. However, VRI will not be effective in all circumstances. For example, it will not be effective if the person who needs the interpreter has difficulty seeing the screen (either because of vision loss or because he or she cannot be properly positioned to see the screen, because of an injury or other condition). In these circumstances, an on-site interpreter may be required.

If VRI is chosen, all of the following specific performance standards must be met:

• Real-time, full-motion video and audio over a dedicated high-speed, wide-bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication;

• A sharply delineated image that is large enough to display the interpreter’s face, arms, hands, and fingers, and the face, arms, hands, and fingers of the person using sign language, regardless of his or her body position;

• A clear, audible transmission of voices; and

• Adequate staff training to ensure quick set-up and proper operation.

• Clear instruction to the participant in the room on use of VRI