Collage of roleplayers

Supporting clients' rights in the workplace

by Judith Vonberg

Employers have a duty, laid down by the United Nations, to make changes in the workplace to accommodate persons with disabilities.

After hiring someone with hearing loss severe enough to be classed as a disability, a diligent employer might request a functional report, which should clearly and concretely explain the impact of the person’s hearing loss and what must be done to accommodate it.  But these reports are often just a clinical description of the hearing problem and difficult to understand for anyone outside the medical world.

Fanie du Toit, senior specialist in hearing impairment and deaf affairs at South Africa’s National Council of and for Persons with Disabilities, sees this problem daily: “Employers often call me and say, ‘I want to accommodate persons with disabilities in my workplace. I’ve built a ramp for the wheelchair user, because I can see he can’t come in the building. I want to accommodate the hearing-impaired person, but I can’t make out this audiogram.’ Can you blame an employer if he’s got an audiogram and he doesn’t understand it?

“It’s not rocket science,” du Toit goes on. “The functional report must just be formulated in a way so that if the person takes it home, their family can understand.”

Input from multiple stakeholders

Together with audiologist Francis Slabber, du Toit has developed a protocol to help hearing care professionals write more accessible functional reports.

The duo has already trained around 350 professionals in South Africa, including hearing care professionals, occupational therapists, social workers, and HR mangers, in how to use the protocol – and du Toit believes the guidelines can be applied in other countries too, with the audiologist role taken on by the occupational therapist, speech and language pathologist, or whoever has the job of writing the final report.

The protocol is built on the belief that no single person has all the skills and knowledge to write a truly functional report. The key is therefore to involve the person with hearing loss, the audiologist, someone from the disability sector, and a representative of the employer in the process.  “They don’t all have to be sitting round a table,” says du Toit. “As long as every person has the chance to give input.”  And he’s keen to stress that a successful functional report doesn’t replace the clinical report – in fact, the latter should be the foundation for and included in the former.

So does the protocol work in practice?

“I’ll stake my life on it,” says du Toit. “I see it work on a daily basis. And I see one important thing – how a focus on the specific individual’s functional needs makes a change in their life.”

‘I want the individual not to have to fight on his own’

Research shows that many people with hearing loss are too afraid to speak to their employer about their condition and the changes they need. Du Toit sees a successful functional report as a tool to enable the individual to start that conversation and educate them on their right to accommodations too.

“I want the individual not to be exposed, I want the individual not to have to fight for his rights on his own. The hearing care professional can help so much to stimulate processes, if they follow this protocol.”

Across the Atlantic in the US, there’s also a growing need for high-quality functional reports – but it’s mostly insurers rather than employers who need them, according to Tricia Ashby-Scabis, Director of Audiology Practices at the American Speech-Language-Hearing Association (ASHA).  In this context, it’s virtually impossible for the person with hearing loss to make any progress without a comprehensive and comprehensible functional report.

Ashby-Scabis explains that professional associations such as ASHA are looking into how professionals can best document patients’ functional goals, but that the solution will likely look different to du Toit and Slabber’s protocol.  “Perhaps this could work in some situations,” she says. “But it’s very difficult to get a universal program going, because care, reimbursement, and payers vary so much state by state, and employer by employer.”


Educate the professionals of the future

The Ida Institute’s Future Hearing Journeys report recommends that hearing care professionals work towards being advocates for their clients far beyond the clinic – and writing good functional reports is part of that.  For this to become the norm, Ashby-Scabis and du Toit see education as the solution, with hearing care professionals of the future taught about relevant legislation and functional report writing, alongside current training on clinical report writing.

“I absolutely see the need for this to be incorporated in core training,” says Ashby-Scabis. “It is something that is being taught in many educational programs, but based upon the work setting the student transitions to after graduation, if it isn’t being supported or promoted by the employer, it doesn’t happen.”  Du Toit agrees that this training should be compulsory, not an optional add-on. “If my training doesn’t include it as a priority, why would I think it’s important?” he asks.

He and Slabber are already delivering lectures to audiology students at the University of Cape Town on disability legislation and functional report writing – and hope to get this content fully integrated into curricula in the future.  They have also developed an online training course (with CPD credits) on the rights of the individual to reasonable accommodations in the workplace and applying those rights in functional report writing.  Ultimately, du Toit sees functional reports as a vital part of holistic care: “You cannot speak about person-centered care (PCC) if you leave the person on the doorstep of the audiology clinic and then they must go out and fight for their rights on their own.”

He wants to see a South Africa – and a world – where hearing care professionals have the knowledge they need to join that fight with their clients.  “This is what we dream of,” says du Toit. “I hope I’ll be able to see this happen in our country in my lifetime.”