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Issues Related to Social and Policy Environments

Time and flexibility are the most valuable tools for meeting the needs of a survivor with a voice, language or speech disorder. A wide range of conditions can cause functional limitations in voice, speech or using language. Some people have issues that date from birth such as the speech limitations related to Cerebral Palsy or acquired in childhood such as stuttering or Tourette's Syndrome. The largest number of people with impairments to voice, speech or language capacity are those who acquired it over the course of life from illness, injury or, in the case of some forms of cancer, as a result of treatment.

The functions, skills and abilities of voice, speech and language are related but different. Functional limitations have very different impacts and it is important to distinguish among them. Sometimes the individual is aware of the limitation and can compensate comfortably. A person who has never been able to use her voice may be quick and articulate with an augmentative device or alternative technology. A person who speaks with great difficulty, such as someone with an extreme stutter, will be able to communicate if offered sufficient patience and time and may choose to use a computer of personal digital assistant. Someone born Deaf who uses American Sign Language (ASL) may or may not also use speech but communicates fluently in ASL. Those individuals whose ability to express and understand language is impaired can be far more complex partly because each person's situation is likely to be unique and may be accompanied by changes in brain function.

As in any other type of functional limitation, the provider should assume that a negative attitude and low expectations are the most disabling characteristic of the social environment for survivors with voice, speech or language disorders.  Be patient, flexible and pay attention to the ways in which the survivor will be able to help you to find a way to communicate effectively in order to help her to achieve safety.

Examples of Problems

  • A telephone intake worker mistakes someone having slurred speech as being inebriated and does not consider the possibility of a speech limitation from stroke, traumatic brain injury, cerebral palsy, or gunshot. The call may never be recorded or tracked at all. 1
  • A survivor who has had a stroke is having great difficulty processing information during a safety planning session scheduled for an hour. She has aphasia and uses only short phrases to express herself and cannot follow the standard procedure outlined by the staff. Both she and the staff person are frustrated after a fruitless hour. The staff member completes the form in lieu of a collaborative process.

Possible Solutions

  • Staff and volunteers should be trained in the telephone communication that may indicate a person with a voice, speech or language limitation is on the line in order to avoid hanging up on a TTY/TDD, Internet Protocol (IP) relay call or Speech To Speech (STS) relay call. See the Accessibility Tab to understand the national provisions relative to telephone accessibility for people who are deaf/hearing impaired or speech impaired. The requirements of Title IV of the Americans with Disabilities Act require the Federal Communications Commission to make available to all individuals in the United States a rapid, efficient nationwide communication service, and to increase the utility of the telephone system of the Nation to everyone. Speech impaired individuals are specifically included.
  • A limitation of voice, speech or language should not result in giving up on survivor participation in any aspect of the program. Providers should learn what methods of communication work for the survivor and implement those techniques.  Assume that it will take extra time. Perhaps someone on the staff has been able to understand her particularly well and could take on developing the safety plan or be called in as an informal communication assistant.
  • A quiet, calm, comfortable and well-lit environment is very important to anyone having difficulty processing information. Space should allow for the use of any augmentative communication devices, alternative technologies or technology such as a computer or personal digital assistant which may serve as a communication device.
  • Come up with a mutually agreeable system for signaling when the survivor needs a moment: "If you are having trouble thinking or concentrating at any time while we talk, let's come up with a way for you to signal me. The signal means that you need a moment before we continue. Perhaps you can raise your hand like this? Perhaps, turn this piece of paper over? That way you can interrupt me." It should be offered even if the survivor doesn't have the confidence or expectation that she can use it.
  • Because of diverse cultural expectations, low self-esteem, or general fear of authority, survivors sometimes struggle with being able to assert when she is missing information, confused, disoriented, or in disagreement. The provider can check in with the survivor throughout conversation by asking the survivor to paraphrase instructions or information to be remembered.
  • A person may need extra help with learning.  A provider may need to develop one-step-at-time instructions, repeat information until it is understood, use graphic depictions of routines and steps, role-play, or reduce expectations of what can be learned in one session.
  • For lists of ideas on how to provide employment accommodations to someone on your staff or a prospective hire with a speech or language disorder, start with the Job Accommodation Network This link will open a new browser window., a free service of the federal Office of Disability Employment Policy of the Department of Labor. Also, see the Employment section on this website for information on employment service centers.

Some of the categories you will find under JAN by Disability A-Z: Speech-Language Impairments, Ataxia, Stroke, Stuttering, Brain Injuries, Cerebral Palsy, Multiple Chemical Sensitivities, Chronic Fatigue Syndrome, Learning Disabilities, Cognitive Impairments.

1Alaska Department of Administration, Violent Crimes Compensation Board, Meeting the Needs of Crime Victims with Disabilities.