Case study | Adults with a sensory impairment-hearing:
What health professionals and other role-players should know
We believe that the concept & principles below may to a certain extent be applicable to all 5 impairment groupings, as per the White Paper on the Rights of Persons with Disabilities 2015 (WPRPD).
Persons with hearing loss often approach us requesting a functional report for their employer to better understand their reasonable accommodation. Dialogue and/or Mediation is impossible with a clinical report, which only describes the clinical loss and recommends hearing aids as management.
Health Professionals must understand the relationship between impairment, disability, and reasonable accommodation, and their reports must comply with the content of disability rights issues. Reports are clinical descriptions, usually only interpretable by other medical professionals in the same specialty field, like ENTs, some GPs, and speech therapists. This is not the language used or understood by corporate owners, employers, HR managers, insurance brokers, or persons with hearing loss who are themselves an integral part of negotiating for their reasonable accommodations. This type of report typically does not quote or reflect any information specified in official legal documentation on the reasonable accommodation of persons with hearing loss and is therefore of little to no value to the individual, their employer, or insurer.
The audiogram which provides evidence of impairment or disability is uninterpretable, inadequate, and not valuable for the motivation for reasonable accommodation. It says nothing about the actual loss, the impact thereof, the disablement experienced, or the reasonable accommodation required. When the health professional recommends amplification, it applies to the responsibilities of the individual but does not speak to the responsibility of, for example, the employer as per legislation. Insurers require a report to state whether a person may be considered a person with a disability.
View the difference between a clinical and a functional report https://www.youtube.com/watch?v=aCSKDzusFWs&t=14s
Still, any report that uses the clinical description and audiogram as proof of disability without describing the impact of the impairment and the functional limitations cannot be used to form an opinion on whether or not a person has a disability.
Health Professional needs to do the basic test battery but mainly include Speech in Noise, free field unaided results, free field aided if possible, and free field speech in noise as well as their Articulation
Index scores. This will give an accurate representation of all the aspects to be considered when describing the functional loss and the reasonable accommodation required.
Health Professionals must use the Protocol Guidelines (https://youtu.be/xEmH9RITS60)* to help identify the functional needs of persons who are deaf or hearing impaired. For this, a comprehensive case history is required – not a medical report but a functional report.
* Video subtitles are available in Google Chrome.
The recommendations for reasonable accommodation have to be backed up by the South African law on the rights of persons with disabilities. Medical professionals are not necessarily trained in the details of legislative issues, and should therefore involve disability rights experts in the process of functional report writing. These experts will address any additional reasonable accommodations needed to ensure that all proposals made are in line with the UN Convention and the White Paper on the Rights of Persons with Disabilities and SA Legislation. For example, they will quote the specific document applicable to the reasonable accommodations recommended by the Health Professional. In this way, all recommendations are factual and based on recognized and documented law.
Dialogue and/or Mediation are impossible with a clinical report, which only describes the clinical loss and recommends hearing aids as management. The report should cover the clinical description, the functional impact, and all the recommendations in line with universal reasonable accommodation principles. This type of functional report will pave the way to a much better understanding on all sides of what it is that the person with the impairment needs and what society can do to relieve any disabilities caused.
It is also a myth that useful reports only apply to the workspace. Any adult with hearing loss (or their families) is entitled to a functional report based on their needs and the merits of their case.
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