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Hong Kong is a small place and it has got a relatively short history of development after World War II. Nevertheless, with rapid economic growth, as early as 1950s, the government and a number of voluntary agencies started rehabilitation services to people with disabilities.
Rehabilitation services to people with disabilities have all along been categorised according to the major disability of the client-in-question. Very often, because of this categorization, quite a number of the multiply-handicapped persons are unable to get the appropriate training or services they need. People with dual-sensory loss, the deaf-blind, is one of the typical examples.
The Deaf-blind in Hong Kong
It is common among parents with deaf-blind children or sometimes even among the rehabilitation workers to mix up deaf-blind people with those of the severely-handicapped. This mainly attributes to the lack of a proper understanding about deaf-blindness. From the survey conducted by the Hong Kong Society for the Blind in November, 1991 and a follow-up survey done in September, 1992 , people with deaf-blindness were found placed in rehabilitation centres for the severely mentally handicapped where the training element was minimal. For those cases whose dual-sensory loss came up at different times during their course of life, they were often left idle or unattended at Home due to the absence of services for the deaf-blind in Hong Kong.
According to Government statistics, as at September, 1996, there were 177 people registered as deaf-blind. Among them, around 60% are aged 60 and above. They are the elderlies according to the local welfare service-target definition. The prevalence rate shows a downward trend when compared to the figures revealed in March, 1993 when there were 392 deaf-blind cases.
Although this is a small target group, we strongly believe that given adequate training programme and supportive services, the deaf-blind are able to make better use of their residual potential and lead an independent living as far as their capabilities permit.
Deaf-blindness is not the sum total of deafness and blindness, it is a unique disability in itself. People with deaf-blindness are in fact diverse in their degree of dual-sensory loss. Some are totally deaf and totally blind, some are totally blind with some hearing, some who are totally deaf but with some vision and some are hard of hearing with low vision. There are people who are born deaf-blind, there are some who acquired deaf-blindness and some even have additional disabilities other than deaf-blindness.
People who are deaf-blind have unique communication needs. There are very few people who are able to communicate easily as they must be familiar with the modes of communication that used by an individual, ie., not all deaf-blind people communicate in the same way.
People who are deaf-blind are extremely isolated from other people. They have difficulty in accessing information, and from moving freely in the environment.
The Need for a Specialized Training Programme for the Deaf-blind in Hong Kong
The Hong Kong Society for the Blind, since its establishment in 1956, has been the only one rehabilitation agency in Hong Kong which offers specialized training to both congenitally and adventitiously visually impaired persons aged 16 and above as well as those with mental retardation.
A comprehensive rehabilitation
programme which covers training in Orientation and Mobility Skills, Home
Management Skills and Communication Skills, Vocational Training, Technical
Aid Support, Employment Guidance and Placement Services are provided to
the visually impaired with normal intelligence or even slow learning at
our Rehabilitation and Training Centre. As for those with mental retardation,
training in self-care, simple motor and pre-work skills, making of simple
handicrafts and social adjustment are offered at our Morning Glory Day
Activity Centre cum Hostel.
Realizing the specific needs of the deaf-blind, in 1991 and again in 1992, the Hong Kong Society for the Blind launched the first and the second surveys about the training needs of the deaf-blind in Hong Kong.
Having got no idea about the profile of the deaf-blind cases in Hong Kong, the two surveys only reached those who were placed in deaf schools, blind schools, adult training centres for the moderately to severely handicapped and the Selective Placement Units where the deaf-blind cases could be identified. Of all the questionnaires returned, 38 deaf-blind cases were identified. Annex I gives the profile of the cases. Before setting up a specialized training programme for the deaf-blind, a second follow-up survey was done in September, 1992 to define the training needs of the deaf-blind. The findings of the second survey was given in Annex II.
Meanwhile, to prepare the staff to launch a pilot training programme for the deaf-blind in Hong Kong, two senior staff from the Society were sent to the Perkins School for the Blind in the States to attend a ten-week Leadership Training Programme with the focus on deaf-blind service. After returning to Hong Kong, a pilot project proposal was made to solicit funding support from local charities. Nevertheless, due to the small size of the target group and the need for intensive training that blew up the recurrent cost, funding application was not successful until late 1994 when the Community Chest agreed to support the Society a limited budget for a case-manager to deal with the deaf-blind cases.
Being inexperienced in the teaching of deaf-blind, in 1994, deaf-blind education experts from the Perkins School for the Blind were invited to Hong Kong to give training to our instructors who had only got experience in the training of the visually impaired and those with mental retardation.
To select cases for admission to the new deaf-blind rehabilitation programme, another survey was conducted in early 1993 to identify those cases that exhibited a training need. Deaf-blind people registered under the Government's Central Registry for the Disabled (now renamed as ' Central Registry of Rehabilitation') were reached by mail to find out their training needs. Of the 392 cases registered under the Central Registry, only 50 returned their reply indicating their interest to know more about our new rehabilitation service for the deaf-blind. Home-visits were conducted subsequently to 16 of them who welcomed our visit. 8 cases were found having the most urgent training needs.
Organization of the Deaf-blind Training Programme
Given the diverse conditions of dual-sensory loss among the target group, we decided to divide our target clientele - the deaf-blind, into two groups: the higher functioning and the lower functioning.
With the limited funding support from the Community Chest, it was almost impossible for the Society to set up a separate team of staff to conduct the deaf-blind rehabilitation programme. Instead, we had to draw manpower and training resources from the Morning Glory Day Activity Centre cum Hostel (MGCH) that serves the mentally handicapped blind and the Rehabilitation and Training Centre (RTC) that renders training to the visually impaired with normal intelligence or the marginal cases.
The Project Team
A project team was set up in late 1994. The following gives the structure.
Supervisor (RTC) Supervisor (MGCH)
Social Worker Social Worker
Senior O & M Instructor
Communication Skills Instructor
Home Management Skills Home Management Skills Instructor Instructor
The above structure is designed to draw experienced instructors from the two centres to serve the two different groups of deaf-blind clients based on their functioning capabilities.
The primary objectives of the deaf-blind rehabilitation programme is to equip the target clientele the necessary skills for independent living as far as their capabilities permit and to facilitate their social integration into the community at large.
While communication is the main factor governing how well the deaf-blind trainee can benefit from the training programme and how well he can interact with their normal counterparts in the community, the project also aims to develop a set of Tactual Sign Language applicable to the Chinese community in Hong Kong.
Also, by drawing the experience from the training as the project goes on, we aim to produce a resource manual in about three years' time as a reference for people working for the deaf-blind and to arouse public concern and general understanding about the specific needs of the deaf-blind.
The following procedures have been established to screen cases for admission to appropriate service centers for the training.
1. Apart from those being identified in the surveys, people approached the Society for service but was found deaf-blind would be put on the waitinglist for deaf-blind service as well.
2. To assess the functional
level of individual deaf-blind and their training needs, the two social
workers from the two centres joined hands to conduct the intake assessment
with a checklist giving details about client's abilities and weaknesses
in daily activities.
3. In addition, the most appropriate mode of service delivery would be recommended based on the physical conditions of the client and the availability of transport for attending day-training at our centres. If home-based training is necessary or considered as more beneficial to the client-in-question, instructors from the corresponding centre will be sent to the client's home to conduct the individualized training. If centre transport is available and that the client's physical health permits travelling, centre-based training will be offered.
4. After medical examination and the client is confirmed as fit for training, admission will be arranged if a vacancy is available.
Individual Service Plan
Rehabilitation of people with disabilities is an intensive task. Also, a team of different professionals is often involved to work out the best plan for an individual. To pursue, Individual Service Plan is worked out for every newly admitted trainee which gears towards meeting their individual training needs and service goals. After the formulation of the first Individual Service Plan for an individual deaf-blind trainee, it will be reviewed annually by assessing on the trainee's actual progress in the year.
A. Ms C
Age : 44
Physical condition :
Vision - totally blind with light perception;
Hearing - auditory defective
Speech - limited and unclear speech
Mobility - normal
Mentality :functioning at the moderate mental deficiency level
Life before admission for
training: left idle at home since
childhood when she became totally blind and hearing impaired at the age of 3.
Training needs identified
Due to the lack of understanding about deaf-blindness, Ms C did not have any training in communication and self-care at all before admission. Hence, communication skills is the basic skills she needs for learning and interacting with people around. Besides, she has to learn self-care skills and daily living skills even if she gets a residential placement.
Judging from her low level of functioning at the time of intake, a placement at our Morning Glory Day Activity Centre cum Hostel would meet the needs of Ms C. A hostel placement would be necessary as her parents have passed away and that her elder brother is unable to take care of her as he is tied up by his own family. She was admitted into the training programme in mid 1996.
Individual Service Plan
Given the serious impairment of both vision and hearing and the lack of any form of formal training previously, it is expected that Ms C will spend a long time in the Morning Glory Day Activity Centre cum Hostel for basic living skills training and for residential care. Training areas covered : communication skills with body language and simple tactual sign language, self care skills and simple eating manner, and motor skills training.
At the beginning, Ms C was quite unmotivated to attend classes and she had a very short concentration span. Behaviour modification and reinforcements were adopted from time to time according to her progress and response. Apart from the use of body language such as patting and gentle touch, tactual signs have been introduced since early March this year to help her to express more about her own feelings and need such as `Hungry', `Happy', `Sick', `Go to toilet' and `Thank you'. The next session would be focused more about expressing herself while attending training sessions in self-care and motor-skills.
It is worth mentioning that
while Ms C is living with people who are visually impaired with mental
retardation and few of them are deaf-blind, social interaction between
Ms C and her inmates should be encouraged so that she would not be isolated.
Because of this, the communication skills training was in fact conducted
in a group setting where three trainees of the same Day Activity Centre
were selected to join Ms C in the training and to share with her in the
group interaction. This approach is found useful as we witness more interaction
between Ms C and her inmates, particularly those from the same training
group, after classes. Though Ms C is still emotionally attached to the
instructor, more than the other do, there is obvious expansion of her social
circle within the centre.
B. Mr L
Age : 42
Physical conditions :
Vision - totally blind with only light perception
Hearing- severe hearing impairment, but can figure out high frequency sound with a hearing aid
Speech - limited speech , able to communicate in speech but not clear enough for normal communication
Life before admission :
Mr L became blind due to Retinitis Pigmentosa and Cataract since his adolescence. Yet he managed to finish his junior secondary education in normal school. Before admission, he was under the care of his parents. Though he stayed at home most of the time, his sisters often brought him to take part in church activities and he loved making simple handicrafts as taught by a volunteer from the church.
Training needs identified
Mr L was eager to attend a rehabilitation programme for the deaf-blind. Mr L wished to go to work in a sheltered workshop and attend church activities by himself when his sister was not available as an escort. Though it was not Mr L 's felt need, his sister and mother would like Mr L to be capable of simple cooking and self-care as the mother was getting old. His family was very supportive and they were prepared to bring him to the centre everyday for attending the deaf-blind training programme.
As Mr L had received education and his psychological report revealed that he was just slow in learning but not mentally deficient, a placement at the Society's Rehabilitation and Training Centre was considered more appropriate to meet his training needs. He was admitted into the Centre in February, 1995.
Individual Service Plan
Given his strong motivation
in learning, the following training was planned for Mr L together with
his family. It included : Orientation and Mobility Skills, Techniques of
daily living and Community Education.
Mr L exhibited good progress since his admission into the training programme. To solve the problem of communication during training, he was encouraged to use his hearing aid and the instructors made use of the `Pocket-talker' to give instruction. He managed to finish indoor O & M training including sighted-guide, self-protection technique, directional concepts and orientation, and indoor cane travel within three months' time. When doing cane-travel outdoor, he had emotional barrier in crossing streets by getting assistance from the passers-by. He was reluctant to take out his card telling people that he was a deaf-blind and he needed assistance to cross the streets. Due counselling was rendered and we asked for help from his family members to give him emotional support to get over the bad-feeling of telling strangers that he was deaf-blind and he wanted assistance. At a later stage of the course, he managed to go back home by himself by taking public bus and travel on the Mass Transit Railway.
Apart from O & M training, he also attended Community Education session together with the other trainees of the Rehabilitation and Training Centre. Although he had problem in hearing and he had limited speech, with a pleasant character, he was able to mix well with the other blind trainees who possessed a single disability only.
Nevertheless, just when Mr L finished O & M training in May, 1996 and started Techniques of Daily Living, he caught cancer in his nose. He died a few weeks later after he suspended from the training.
Progress of other cases
Apart from the above two cases described in detail, there were four more cases admitted in the year of 1996 for the deaf-blind training programme. One of them was placed in the Morning Glory Day Activity Centre cum Hostel like Ms C and the other three were admitted into the Rehabilitation and Training Centre for training in higher level of functional skills in independent living. Only one is aged 21, the rest are in the range of 40s. Home-based training in O & M and handwriting were rendered to a deaf-blind lady, Ms T, who became totally blind with moderate hearing impairment due to menigitis since 1987.
In April, 1996, two experts from the Hilton Perkins International Programme, Mr Kirk Horton and Miss Marianne Riggio, came to Hong Kong to conduct an interim evaluation of the Deaf-Blind Programmme. They were pleased with the progress made in Hong Kong.
Concerning the development of tactual sign language for the deaf-blind living in a Chinese community, we are fortunate to have a volunteer, Father Cyril Axelrod, also a deaf-blind person of Usher Syndrome, to help us to develop a system of Chinese Tactual Sign Language. He has been working for the Chinese deaf community for more than twenty years in Macau and Hong Kong. He is enthusiastic to help in developing the deaf-blind programme as he himself is one of the sufferers. The progress is satisfying and a video showing the tactual signs developed for daily living skills training is produced.
The next step will be to compile a Resource Manual for the Deaf-blind Programme in Hong Kong. Again due to limited manpower, volunteers will be solicited to work out the draft according to our past two years' experience in deaf-blind training and to borrow the effective techniques in deaf-blind education abroad.
Projection of the Service
Although the deaf-blind population in Hong Kong is relatively small. In face of the lack of expertise in deaf-blind training, the Hong Kong Society for the Blind will take up the leading role to accumulate experience in the specialized training by means of a Resource Manual and to share with the other service providers understanding of the specific needs of the deaf-blind and teaching skills through regular workshops and seminars.
Given the limited understanding about the deaf-blind, public awareness campaign is necessary to promote a concern for the deaf-blind and their well-being in a community that their accessibility to services and facilities is often neglected.
Finally, because of the small population, it is our ultimate goal to help the deaf-blind to formulate self-help groups among the deaf-blind so as to reinforce their mutual support and collective rights in the community.
To start new service and to help the minority to stand on their own feet in the community that is often not favourable to their survival often meets with big hurdles. Yet the Hong Kong Society For the Blind strongly believes that with confidence and courage, nothing can be obstacles on our way to success.
12 June, 1997