Speech-to-Speech
A free national telephone relay service
for people with speech disabilities
The following presentation was be handed out to attendees at the DISABILITY AND SPECIAL NEEDS TECHNICAL ASSISTANCE CONFERENCE (Emergency Preparedness, Response, and Recovery) – January 8-9, 2008 at the Capital Hilton, Washington DC
The ability and freedom to communicate with others, whether spoken or written, is something most take for granted. When most people go to speak, they expect a clear voice to come out. Whether talking to a co-worker, reading to one's grandchildren, or reminiscing with an old friend, most people take their voice for granted. But for those with speech disabilities, a reliable voice is no longer guaranteed. The sound that comes out may not accurately represent the feelings of the speaker. People with communication disabilities were not able to communicate outside of their world until Telecommunications Relay Services came along, and made the use of the telephone possible for them. Now they can take care of routine matters such as making doctor’s appointments, making business calls, calling friends and relatives, etc. Telecommunications Relay Services has made even calling 9-1-1 for emergency situations possible for persons with speech disabilities.
Two relay services that people with speech disabilities can utilized are Speech-To-Speech (STS) Relay and Hearing-Carry-Over (HCO) Relay. With STS Relay you can use your voice and hear at the same time, but have a communication agent (CA) “revoice” what you say verbatim --- like real time telephoning. For HCO Relay your voice is not heard, but you can hear the party you are calling; and you type back to the communication agent what you want to tell the other party. A TTY and a speakerphone are used for this type of relay service.
People with speech disabilities have two things going against them when speaking, and that is having trouble speaking and being understood. Therefore, it is with much hesitation that speech disabled individuals use the telephone. There are many varieties of speech disabilities, and many speech disabled individuals have other disabilities as well – and some use wheelchairs. Some speech disabled individuals do not have the cognitive or manual skills to use a telephone or a computer keyboard.
For those who lack the manual skills a pointer or stick is used to strike a key on a computer keyboard – this same method is also use to dial a number on a telephone. Also a switch is used to manipulate signals on a computer screen. Most people with speech disabilities use a variety of adaptive equipment for communication such as the one that is being held up. This is a much more sophisticated augmentative communication device than some. On this particular device you can program sentences or even a whole presentation/speech. With a click of a key your speech is communicated for you. You can connect this particular device to a cell phone for a direct call using certain programmable keys for certain conversations – for example “Hey! How are you?” Users of this equipment often call through Speech-to-Speech Relay so that the communications assistant can manage the call and insure that the other caller understands and respects the turn taking process.
Now, you may be saying to yourselves, what does this have to do with accessing 9-1-1? I am attempting to explain that it takes an enormous effect and time for a speech disabled individual to communicate. Sometimes “time is of an essence” when one is trying to access 9-1-1. A speech disabled individual, just like most people, becomes more excitable and frustrated in an emergency situation but this excitement makes their speech more difficult to understand. In some situations, a speech disabled individual can call 9-1-1 directly without using a relay service and simply leave the phone off the hook; in other instances, an individual with a speech disability may need to access 9-1-1 through Speech-To-Speech Relay in order to specify the type of help needed. Time is not quick enough when you have to access 9-1-1 by dialing Speech-To-Speech Relay and making the communication agent understand that this is a 9-1-1 call. Dialing 7-1-1 (a national call number for telecommunications relay services) takes longer because 7-1-1 operators may not understand that a speech disabled individual is calling.
Unfortunately, 9-1-1 operators are not trained to respond to calls from people with speech disabilities. It would not be cost effective to provide Speech-To-Speech training to all 9-1-1 operators nationwide given the limited anticipated use of 9-1-1 by speech disable individuals. A more cost effective approach would be to educate speech disabled individuals nationally to access 9-1-1 directly or through Speech-To-Speech Relay, depending on the situation. Such education can be financed with grants from various sources.
Thus, a prerequisite to emergency access training for speech disabled individuals is to teach them to use Speech-To-Speech Relay. This leads back to the necessity of developing Speech-To-Speech training in the 40 or so states that lack such training programs.
These are the typical barriers for people with speech disabilities:
1. Many individuals with a speech disability don’t have telephone equipment that they can use at all. They may need a speakerphone, headset, or TTY. They don’t know where to request the equipment. If they can not use a phone or have access to one, they can not call 9-1-1.
2. Family members or caregivers sometimes forget to place a phone within reach of an invalid or wheelchair bound individual that has a speech disability – this person, then, has no accessible way to call 9-1-1.
3. Many speech disabled individuals lack the dexterity to use the telephone even with special equipment. If special equipment is not provided for special needs, there would be no access to 9-1-1.
4. Many speech disabled individuals lack the social skills or cognitive skills to identify an emergency situation.
5. Some speech disabled individuals can not afford to have telephone service
6. If a speech disabled individual had to access 9-1-1 through Speech-To-Speech Relay (because the 9-1-1 operator can’t understand their speech), the Speech-To-Speech Relay answer time may be too long for the emergency situation. Also, depending on the emergency situation accessing 9-1-1 via Hearing-Carry-Over Relay would also take a long time to explain the type of emergency situation because the communication agent would have to wait until the user typed his/her message – and the user may be a slow typist.
7. Many speech disabled individuals do not think that the 9-1-1 operator will understand them and they do not know that they can access 9-1-1 through Speech-To-Speech Relay. They assume that 9-1-1 is not available to them.
8. Public telephones are often not wheelchair accessible and many speech disabled individuals use wheelchairs.
9. Public telephones are often in noisy areas, and speech disabled individuals are often more difficult to understand when there is background noise.
Therefore, the hesitation of a speech disabled individual to call 9-1-1.
Some possible emergency preparedness suggestion/solutions are:
1. Administer a national outreach program explaining all relay services.
2. An emergency community center should be set up to identify who is deaf and/or speech disabled. (Neighbors looking out for neighbors who are disabled and/or elderly).
3. People who are non-speaking should consider wearing a medic alert bracelet – these should carry a basic msg. For example, "I cannot speak but I can hear. I use (symbol board, computer voice, etc). Please try and take my communication device with me."
4. It should be mandatory that hospitals (at least in major centers) should have a symbol board in the ER. If the deaf community has interpreters, why not revoicers for people with speech disabilities who come to the ER? Probably required under the ADA.
5. 9-1-1 centers call takers should be familiar with Speech-To-Speech Relay calls (through educational programs). If someone with a speech disability cannot be understood by the 9-1-1 operator, the operator should know to ask them to call back through Speech-To-Speech Relay.
6. People who have a communication disability should a have some kind signal light that would help to locate them.
To sum up what has been said, and looking towards the future, all Americans need rapid response from first responders. Therefore, all stakeholders in the provision of emergency number services must be committed to define and implement short-term and long-term solutions to ensure that those who are deaf, hard-of-hearing or with speech disabilities can summon emergency services when needed.