Robert M. Aber, Ph. D.,
State Licensed Psychologist (CA)
STS Consumer, Los Angeles

Supplemental Input in Favor of Mandatory National
Speech-To-Speech Service.

Notes on the Need for an Effective Outreach Program

PLEASE IGNORE THE PREVIOUS EDITION OF THESE COMMENTS
THE AUTHOR EXPRESSES DEEP GRATITUDE TO
AMY S. FRIEDMAN, BROOKLYN, NY
FOR HER KINDNESS IN CORRECTING AND CLARIFYING THESE REMARKS

As a clinical psychologist (UCLA '62; USC '68) with athetoid
cerebral palsy (ambulatory) since birth and significant speech
disability, my comments on the above derive from personal and
professional experience.

The thrust of current arguments by AT& T, Bell-Atlantic and
others -- including potential STS-carriers and interested persons
concerned with cost-effectiveness --against a Mandatory National
STS Service centers on two factors:

-Nationwide low STS call volume by speech-impaired populations
-Nationwide high STS costs due to training needs and
labor-intensiveness.

Both factors are less than reliable due to the following:
1) Outreach Efforts Are Underfunded, Indifferently Managed or
Completely Absent.

With few conspicuous exceptions, the speech-disabled community is
shy, reticent and passive. Test measurement scores in ability and
achievement
among speech-disabled persons are significantly beneath test
scores made by persons without a speech disability. "Learned
Helplessness" is but one descriptive term for apathetic, and
passive-dependent behavior seen --to a greater or lesser extent
--in every member of this population. HERE, THE AUTHOR DOES NOT
EXCEPT HIMSELF.

Are speech-disabled persons mentally or emotionally retarded?
Some are, others are not. However, it is the APPEARANCE rather
than the ACTUALITY of retardation in these realms that usually
determines the quantity and quality of efforts extended by
professionals to improve quality of life for speech-impaired
children or adults.

Professional and popular literature overflow with such examples:
My Left Foot became an Academy Award-winning motion picture for
its star, Mr. Daniel Day-Lewis. It is instructive to note that My
Left Foot the movie, came to wide attention more than a
generation after My Left Foot the book was written.
The movie was released several years after the accidental death
--asphyxiation due to choking and swallowing, age 47 of its
author, Mr. Christy Brown.

Are test scores made by speech-disabled persons valid? Again,
some are, others are not.

Administration of timed standard IQ and educational tests such as
Wechsler Intelligence Scale for Children -Third Edition
(WISC-III); Wechsler Adult 1

1 Page 2 3
Intelligence Scale -Third Edition (WAIS-III-R); Wide Range
Aptitude Test -Revised (WRAT-R) are administered to
speech-disabled persons by Psychologists, Psychology Assistants,
Psychiatry Residents and other state-licensed personnel.

Often, through no fault save inexperience, these and similar
tests are routinely administered to speech-impaired persons with
motor coordination impairment WITHOUT MODIFICATION OR ALLOWANCES
MADE FOR SUCH IMPAIRMENTS. Worse, such "mistakes" are repeatedly
made by experienced personnel whose weight of experience should
have told them otherwise --but, somehow, has not.

(At age eight, the author of these comments was found to have an
IQ in the Educable Mentally Retarded Range [75-89) by a
psychologist appointed by the Los Angeles Unified School
District. This raises the possibility of an important conclusion
--that the author may presently be an overachieving Mental
Retardate. When attempting, some years ago, to retrieve his
childhood records, the author was informed the records are
"lost." Thus, sadly, the tale must remain apocryphal).

Can psychologists and other professionals assess speech disabled
persons with reasonable accuracy?

Often yes, although most graduate psychology curricula does not
include such preparation. Additionally, funding limits imposed by
managed care facilities and HMOs necessarily reduce the chances
of a child or adult who is motorically and speech-disabled to
receive ability/ achievement testing by an experienced, skillful
professional.

Treatment Authorization Requests (TARs) must accompany every
request for a psychological test evaluation. The HMO makes a yes/
no (will pay/ will not pay) determination based upon criteria
describing medical need( s). Eligibility Evaluators (EEs) for
fiscal intermediaries (private insurance companies) are
responsible for the distribution of Medicaid, Medicare as well as
private health insurance monies). In turn, EE's carry out policy
set by insurance actuaries whose interests are best served by
observing the Fiscal Intermediary's "bottom line."

Under the Managed Care system, the EEs, by no means the highest
paid force in the insurance industry, become "gatekeepers" to the
company largesse. EEs are also "a phone call away." As such, they
are the direct recipients of frustration, disgust, outrage,
contempt and, finally, formal appeals by patients, school
districts, families, Regional Centers, Disability Advocates
and service providers (physicians and psychologists, in this
case).

Naturally, EEs make errors in determining Medical Need. Some
errors are more readily correctable than others. One of the least
"correctable" of possible errors is to expect immediate autonomy
and self-sufficiency from a speech-disabled person who has had
years to regard himself/ herself as "backward" through early and/
or repeated inappropriate testing and assessment.

These remarks have included a small sample of ways that the
communication needs of the speech-disabled may be underestimated
and denied by families, caretakers and, worst of all, by the
speech-disabled themselves.

It is not reasonable to expect an STS outreach program, manned by
personnel -- however "well meaning" --who, by reason of
temperament, training and/ or experience are unable to cope with
the innumerable and labyrinthine causes of Learned Helplessness
among speech-disabled persons. It is not reasonable, absent a
well-managed STS Outreach program with factors noted above, to
base success or failure of an STS program merely on number of
STS calls made within a given time frame. Causes of passivity and
the required rehabilitation of speech-disabled persons do not
lend to easy quantification.

It is not reasonable for actual and potential STS carriers to
dismiss the "case-by-case" approach to STS outreach as, itself,
too costly and labor-intensive. Once a "potential" STS user
becomes an active STS user, a "ripple" effect sets in:
Specifically, repeated use of STS involves the speech-disabled
person more actively in the community at-large. Commercial and
private parties become aware of STS AS A WAY TO REACH A
HERETOFORE UNREACHABLE SEGMENT OF THE POPULATION -THE SPEECH
DISABLED COMMUNITY -WHICH, AT A 90-CENT PER MINUTE RATE (PAYABLE
FROM THE CALIFORNIA PUBLIC UTILITIES COMMISSION TO MCI, INC.)
SHOULD GO FAR TO ASSUAGE THE "COST/ LABOR INTENSIVENESS"
OBJECTIONS RAISED BY AT& T AND BELL-ATLANTIC AS POTENTIAL OR
ACTUAL STS CARRIERS.

THE "HIGH" COST OF A NATIONAL STS SERVICE 
Potential or present STS carriers can lower their costs of
providing efficient, full-time STS service with technology
already in common use.  Some examples follow:

1. Using Inmates as STS Call Assistants
CBS's "60 Minutes" ran a segment involving long-term inmates of a
Texas Women's Prison working as "travel agents" for a nationwide
travel agency.  Customers dialing the firm's 800 number to plan
business or pleasure trips were unaware that the agent was a
prisoner who not only had never been to places requested, but
would never travel at all, in all likelihood. Considerable study
and preparation, naturally, was required. Consumers and "agents"
each reported satisfaction. "It certainly beats letting my brain
rot while I'm in here" was a typical prisoner comment.

Clearly, STS carriers could recruit, train and utilize Cas (call
assistants) from male and female correctional facilities with
lowered costs and in a manner consistent with preserving prison
security and caller confidentiality.

2. Call Forwarding" equipment could be utilized to forward STS
calls from speech-disabled users to a limited pool of CAs who the
caller has found satisfactory and "easier to use." CAs differ in
temperament and style just as do speech-disabled people. (As an
STS consumer, the author prefers CAs who are quick, efficient,
thorough, has a sense of humor, will "stay in the background" in
order to help as needed, grasps when the call is "time
sensitive," knows [after being told] when the author wishes or
does not wish to be called "Doctor").

MY PARTICULAR "COMFORT ZONE" FOR CAs IS WIDENED BY

Being as polite as time allows. Speaking and enunciating as
clearly as possible. Treating ALL CAs as persons rather than as
tools provided for my convenience. Remembering that CAs have good
and bad days, too. Calling the CA only by his/ her number.
Praising the CA to his/ her supervisor --if time permits.

"Comfort zones" will differ for persons with significant speech
disabilities. When a particular CA does well in transmitting such
a person's phone communication, in-place call-forwarding
technology could route the particular caller to one of a set of
CAs who are "known" to the caller. The "uncertainty factor" is
diminished for STS users. Call forwarding technology would reduce
the need for CAs to be at a central locale and/ or attending to
STS duties only. "Comfort zones" --an admittedly subjective and
unquantifiable entity --would be significantly increased
--increasing the likelihood and probability of very quantifiable
STS call volume.

The author recommends adoption of a National STS Outreach Program
and use of existing carrier technologies to demonstrate the
intrinsic and economic value of a national STS program.

To demonstrate the efficacy of such a pilot program, the author
will be happy to represent carriers in areas where reported STS
call volume continues to be poor.
Thank you.
Robert M. Aber, Ph. D.,
Licensed Psychologist (California)
e-mail: popshrink@ aol. com >>