Mag - I've been giving presentations on Speech-to-Speech for five years and
that joke always goes over well. Here's a longer article on Speech to
Speech FYI - Bob
Title: Extending Telephone Service to Many People with Speech Disabilities
PART 1: INTRODUCTION
People with moderate to severe speech disabilities in nine states can use a
special telephone service 24 hours a day. This service, called
Speech-to-Speech (STS), grew out of my own attempts to be understood over
the telephone despite my cerebral palsied (CP) speech. STS provides
communications assistants (CAs) for both voice synthesizer users and people
with moderate to severe speech disabilities who have difficulty being
understood by telephone. The Federal Communications Commission may require
STS to be provided nationally in several years.
STS is now offered in nine states 24 hours a day: Arizona, Wisconsin,
Minnesota, Washington, South Carolina, California, Maryland, Georgia, Nevada
and Australia.
People with speech disabilities call a toll free number to use STS.
STS extends telephone use to many people with speech disabilities who cannot
use regular telephone service or the TTY Relay Service. Users now access STS
through a toll-free STS number at the relay service. Previously, relay
services were only accessible for calls between TTY and voice users. While
CAs previously only translated TTY output to voice and vice-versa, now
specially trained STS Cas repeat the words of the person with the speech
disability to the listener.
While STS uses technology analogous to 3-way calling technology, it
provides a human interface that 3-way calling does not. Three-way calling
requires users to provide their own Cas and STS does not. Providing 3-way
calling alone is not sufficient as only very rich people can afford to have
CAs available around the clock in the way that STS CAs are available.
PART 2: USERS OF STS
All STS users have speech which the general public has difficulty
understanding. These users may also have dyslexia or limited hand use (from
CP, head injury, degenerative conditions or strokes) which precludes
keyboarding adequate to use a TTY relay service. Most STS users are probably
adolescents and adults with CP or similar developmental disabilities.
Most STS users can be understood by patient listeners with acute
hearing and excellent speech language skills. New CAs only need a few hours
of experience listening to people with such speech disabilities. Yet, STS
cannot assist people with speech so idiosyncratic that they are only
understood by those who know them well.
Some people communicate on STS with a speech synthesizer or an
artificial larynx. They require voicing services to facilitate communication
similar to other users. Speech synthesizer and artificial larynx users also
require CAs to be patient, experienced listeners who keep the able-bodied
user's attention and facilitate turn taking in communications. Many such
users find that STS compensates for the general public's unpreparedness for
the unusual sound of their devices or the turn-taking required for
communication. There are also some speech synthesizer users who can use the
telephone independently without STS.
Providing telephone access to all such people broadens the historic
contribution of relay service. Direct, speedy telephone access helps
mainstream these people into jobs and many other activities. Such service
expansion reflects the spirit of the Americans with Disabilities Act (ADA).
The ADA advocates expanded applications of new technology to benefit all
people with disabilities.
There is no central source for locating STS users. They must be
identified one-by-one and their fears must be resolved before they were
willing to use STS. For a state to successfully build a STS user
constituency, an intense outreach effort is necessary. In California two of
us, both professional counselors, spent 18 months canvassing the state to
find new users.
That is a primary reason why California has such a high STS call volume
compared with other states.
We called and wrote agencies and mailed thousands of flyers. We
focused on secondary providers who served this population to identify
potential users. Many users were recruited through their Department of
Rehabilita-tion counselor. Other recruitment sources were: 1) Speech
pathologist members of the California chapter of the American Speech and
Hearing Association and the United States Society for Augmentative and
Alternative Communication, 2) Regional Centers in California serving clients
with speech disabilities, 3) Distributors of speech synthesizers sold in
California, 4) local Alliance for Technology agencies in California, 5)
United Cerebral Palsy of California and 6) Independent Living Centers.
Our screening process identified potential STS users with the
appropriate degree of speech disability. To be selected eighty percent of
what they said had to be understood by the patient screener with acute
hearing. They had to speak in complete sentences and have the social skills
to hold a meaningful conversation.
STS is only useful to people with speech that
CAs can understand most of the time. Therefore, we did not recruit people
who are not understood most of the time. Screening also insures that users
have sufficient
telephone knowledge and experience to use STS. Potential users also have to
demonstrate enough responsibility in other aspects of life so that we could
expect them to find STS useful.
PART 3: NOVEMBER, 1995 TRIAL
We conducted a one month system trial in California. Costs included:
training CA, CA's salaries, setting up work stations, use of an 800 number,
and administrative costs.
The CAs voiced what the user with a speech disability said after every
three to four word phrase. That is also the procedure that works best in
face-to-face voicing.
We wanted the trial to utilize Cross-Hearing. That is, to maximize
communication, the CA, the user with a speech disability, and the
speech-able user must all be able to hear each other throughout the call.
Unfortun-ately, cross-hearing was not available for the 1995 trial.
The caller understandability criteria limited the number of times
that a user with a speech disability could repeat a word or phrase without
CA comprehension. After two repetitions the CA would ask the caller to "say
that another way" or "say something else".
The former TTY CAs only needed a few hours of additional training
prior to working as STS CAs in the trial. For the permanent program, audio
tapes from the trial can be used to train additional CAs. These audio-tapes
can give prospective CAs a "feel" for this type of relay work.
Twenty-five trial participants initiated or received 2,000 outbound
telephone calls over 4-weeks. Some calls were made to trial participants by
able-bodied users.
This first trial determined that STS is readily usable on an ongoing
basis by this population. It can be effectively and efficiently run as part
of a TTY relay system.
The trial showed that in a permanent STS service the CA and both
callers must be able to hear each other throughout the call. We also
learned that CAs had to be taught how to respect callers with speech
disabilities. CAs were wisely selected for the trial based on good hearing
and patience. Training by someone with a speech disability was necessary.
The trainer had to be available several hours a day during the trial.
The 25 speech disabled users initiated over 2,000 outbound calls.
They could make calls between 1 pm and 5 pm, Monday through Friday. Now
calling hours are 24 hours a day, seven days a week.
Calls were tape-recorded. Listening to those tapes helped verify the
service's potential to provide successful telecommunications services for
STS users.
The STS CA's role is similar to the TTY CA's role, but in STS user's
speak rather than type. The CA facilitates communications between the user
with a speech disability and a speech-able user or another user with a
speech disability.
The STS CA : 1) Expects to hear distorted speech and is therefore
not shocked or confused by them, 2) Uses earphones to eliminate all
background noise, 3) Has acute hearing, 4) Can concentrate on understanding
the words as the CA has no interest in content or no emotional involvement
with the speaker to distract her/him, 5) Can solicit the speech-able user's
patience. The speech of the trial participants was usually understandable
under these favorable conditions.
The trial showed that: 1) The telecommunications message can be
conveyed with a tolerable level of
frustration for the users and CAs, 2) Speed of communications is increased
compared with that experienced relay calls initiated by very slow typists.
PART 4: THE 1996-1997 TRIAL AND THE PROVISIONAL SERVICE
A second trial (June 1996 to December 1997) resulted in a
provisional service. During most of that trial two outreach workers with
counseling degrees worked full-time. We developed a outreach model which
helped identify the best ways to find STS users.
We telephoned a large proportion of California
neurologists, physical medicine physicians and otolaryn-gologists (ENT).
About one in five neurologists has at least one patient with a speech
disability. Physicians were reluctant to make referrals until we identified
our medical-counseling credentials. We received the most positive response
from physical medicine physicians and those speech therapists who work in
hospitals.
The psychological resistance of potential users often required us to
telephone them up to ten times before they initiated a STS call themselves.
Family members and caretakers can require counseling if they feel a loss of
role and power when people with speech disabilities start to use the
telephone independently.
Outreach was crucial to increase the user base so that the
California Public Utilities Commission (CPUC) could justify removing STS
from provisional status. There are now an 125 estimated users.
The service is a success! Consumers like the service which they
demonstrate both by the high call volume and by their comments. As of
September 1999, an estimated 150 users made more than 4,000 calls a month.
This is double the number of call being made in June 1996 when the current
trial began. Most consumers say that the CAs understand their speech most of
the time and that their calls are successful. California consumers were
very pleased when STS became a permanent service in October 1999.
STS allows many customers to use the telephone independently for the
first time! When one customer was asked if she would attempt the same calls
on her own without STS, she replied: "Never in a million years!" Several
employers of users say that using STS has improved on the job communication.
One user plans to apply to law school if a permanent STS system becomes
available so she can telephone clients.
Dr. Judy Montgomery, Past National President of the American
Speech-Language-Hearing Association said that STS relieves the able-bodied
caller of responsi-bility for deciphering garbled speech and allows her to
concentrate on the content of the call. An aide to the Governor noted that
STS's potential to increase employment of Californians with speech
disabilities.
PART 5: CONCLUSION
Now that STS has become permanent in California, we hope that the
Federal Communication Commission will require STS to be available everywhere
in the US in several years.
Footnotes: 1) Next to getting married and earning a Ph.D., helping
to start STS is the most exciting thing I ever did. I had the joy of
helping others overcome what has been my worst frustration. In psychological
terms, working to provide telephone service to others with speech
disabilities has been for me a task at the very top of Maslow's scale of
human activity. 2) Some of this material was published previously elsewhere.
Bob Segalman, Ph.D., Research Analyst
Program Evaluation and Statistics Section
California Department of Rehabilitation
2000 Evergreen Street; Sacramento, CA 95815
phone 1-800-854-7784 or 916-263-8689
[log in to unmask]
See the STS web site: http://stsnews.com/
----- Original Message -----
From: Magenta Raine <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, December 12, 1999 12:07 PM
Subject: Re: Fw: Telephone Access for People with Speech Disabilities
> In a message dated 12/12/99 11:52:06 AM Pacific Standard Time,
> [log in to unmask] writes:
>
> > Most of them are young women
> > as young people hear better and men don't listen (smile
> lol! oh bob, what a sense of humor! Well, i am off to the web!
> mag
>
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