CART for Elder Law Attorneys

Realtime Captioning for the Hard of Hearing –

Cutting Edge Technology to Help You Communicate Effectively with your Clients and Market your Practice

By Janet L. Smith, JD
Law Office of Janet L. Smith, PS
1833 N. 105th St., Suite 101
Seattle, WA 98133
(206) 937-6102
Presented in cooperation with the CCAC – the Collaborative for Communication Access Via Captioning

The Collaborative for Communication Access via Captioning (CCAC) is a grass-roots collaborative of individuals from many professional and other backgrounds who engage in, support, and may work together on advocacy projects to increase access for people with hearing loss through captioning. Established in December 2009, CCAC manages an active online community to share captioning advocacy information from city, state, and national projects, to examine gaps and needs for captioning, to build a knowledge database about all ongoing captioning projects, and to stimulate new captioning projects where gaps and needs exist in many places. Contact to request participation.

As elder law attorneys, none of us would intentionally meet with clients or give presentations in locations that were not accessible to people who use walkers or wheelchairs. At the same time, few elder law attorneys have given much thought to how we can make our meetings, presentations, and court hearings more accessible to our clients who are hard of hearing. According to the National Institutes of Health, nearly a third of all adults age 65-74 , and 47 percent of adults 75 or older have a hearing impairment. Only one out of five people who could benefit from a hearing aid actually wears one. Among seniors, hearing loss is the third most prevalent, but treatable disabling condition, behind arthritis and hypertension. Talking louder or using amplification isn’t the answer. The problem for hard of hearing people is speech recognition. Certain letters (m and n, or b, c, d, e, t and v) and certain numbers sound alike. The letter is often never heard, so many operate with misinformation, such as thinking singular, when a plural meaning was meant. Hearing loss creates challenges preventing the listener from understanding higher pitched voices, regional or foreign accents or distinguishing between consonants. In addition, vanity plays a role.

Many hard of hearing people are embarrassed, think they have a flaw and therefore are flawed individuals – and will not admit when they don’t understand, or need something repeated. Problems increase in rooms with more than one speaker (examples include depositions or mediations). The hard of hearing senior might only be able to hear people sitting on his “good side”, and may not understand a thing if more than one person is speaking. In a presentation to an audience, even if the speaker is using a microphone, speech recognition can be difficult. Perhaps the worst situation is a crowded courtroom. The acoustics are often bad, background noise high, legal language difficult to understand, and comprehension decreased due to stress and fatigue. The first step is to learn good communication skills for speaking with the hard of hearing. At the back of these materials is a tip sheet on communication with persons who are hard of hearing. The purpose of this presentation is to introduce elder law attorneys to the benefits of using real time captioning for communication access.

CART was demonstrated at the General Session earlier in the program. Communication Access Realtime Translation – CART. What is it? CART is an acronym that stands for Communication Access Realtime Translation. It is a speech-to-text interpreting service for anyone who needs communication access. CART benefits people who are late-deafened, hard of hearing, culturally Deaf, who have cochlear implants, and those learning English as a second language. CART is also referred to as realtime captioning. Page 3 How much does this service cost? The costs of CART services range from $60/hour up to $200/hour, depending on many different factors, such as output method, equipment involved, the type of event, the experience of the CART provider and whether the service is onsite or remote. However, in the court room, CART should be available at no cost to the consumer. How does it work? The CART provider receives an audio feed. Using a steno machine and cutting-edge software, CART providers “write” on their steno machine using phonetic shorthand that they have gone to school to learn. The phonetic shorthand is then translated against the CART provider’s dictionary.

The software finds the associated word in the dictionary with the phonetic shorthand stroke written on the steno machine, translating instantaneously into English. CART providers can be certified to type up to 260 words per minute with 98% accuracy and above. There are many ways to view the streaming text provided by the CART provider. If the CART provider is onsite with the consumer, the realtime text can be viewed on a laptop. The text can be projected onto a screen as well. Another display option is an LED board, which can display up to three lines of text and is supported by a large tripod. The streaming text can also be viewed on many smart phones or on the web. The CART provider will provide the consumer an email with a link to view the streaming text. There are many programs that can be used, but the consumer requires no special software to view the text. Can the service be performed remotely? CART can be used very effectively remotely. The consumer would need a wireless microphone, an Internet connection and a computer. The receiver for the wireless microphone is plugged into the consumer’s laptop. The speaker wears the wireless microphone, which allows the CART provider to hear everything that is said. The text is then streamed from the CART provider’s computer through the Internet and displayed on the consumer’s computer screen. Page 4 What is the minimum equipment needed?

If you are interested in the remote CART service, you need an audio source for the CART provider, which could be voice over IP, commonly referred to as VoIP, which requires a wireless microphone or a telephone line. You also need to have an Internet connection and computer or smart phone. If you are looking for onsite CART, your CART provider may be able to provide all of the equipment needed. If you want it projected onto a big screen, it would require a projector and a screen. Who pays for this? There are several laws related to CART and the requirements to provide it. The venue you are interested in will determine which law would be applicable and who is responsible for the payment of the service. The laws that deal directly with communication access include: Section 504 of the Rehabilitation Act, the ADA, IDEA amendments of 1997, and Section 508 of the Rehabilitation Act. For more information, go to the CCAC website, and look at “Breaking Down Laws Applicable to CART”. Do I get an electronic copy of the transcription at the end?

The CART provider has the capability to provide you with a copy of the streaming text. Whether a transcript will be provided is decided on a case by case basis. If a transcript is requested, arrangements should be made in advance. Do I own the copy of the transcript? The party who hires the CART company to provide services owns the transcript. The transcript should not be disseminated or distributed without the consent of the hiring party. What happens if I do not provide it? Am I violating any law? Not providing equal communication access could be a violation of the ADA, the Rehabilitation Act and IDEA. Page 5 Are there any government grants to cover these expenses? Under the ADA, Rehabilitation Act and the IDEA, the cost of the service is to be covered by the entity that is putting on the event where CART is being provided, unless they can show that the expense of providing the service would be an undue burden. Why can’t we just provide ASL interpreters for everyone? According to the Centers for Disease Control, there are approximately 37 million people who are Deaf and hard of hearing in the United States. Just under two percent (2%) or approximately 600,000 of those 37 million people with hearing loss in the United States communicate through American Sign Language (ASL). Not all individuals who are deaf and hard of hearing “speak” the same language. ASL is a language, and many people who communicate through ASL may not have the reading comprehension or speed necessary to utilize CART.

Likewise, many individuals who are deaf and hard of hearing, especially late-deafened adults and those who lost their hearing after learning speech, read lips and rely solely on CART and captioning in group settings. There is not a one-size-fits-all solution when dealing with communication access. The consumers should be allowed to pick the accommodation that best meets their individual needs. CART as “Reasonable Accommodation” In August, 2001, the U.S. Ninth Circuit Court of Appeals determined that CART may be a reasonable accommodation for deaf and hard-of-hearing people under the ADA. The case, Duvall v. County of Kitsap, 260 F. 3d 1124 (2001), involved a profoundly hard of hearing man who wanted CART interpreting for his divorce proceeding in state court. The judge denied the request, in part because CART was not considered to be a reasonable accommodation for his hearing loss. The Ninth Circuit reversed and remanded the issue for trial, saying that sufficient evidence had been presented to raise a question of fact on the issue of reasonable accommodation. Page 6 What is the difference between CART and captioning? “CART” and “captioning” are often used interchangeably when in fact they are two very different services. CART is a text-only translation of the spoken word displayed on a computer screen, LED board, large screen via LCD projector, or over the internet. Captioning is text displayed in conjunction with a video image and requires an encoder or character generator as well as captioning software on the provider’s computer.

What is the difference between open captioning and closed-captioning? Open captioning is CART or captioning text which can be seen by everybody, thus the term “open”; whereas closed-captioning must be “turned on” before it can be seen. If text is streaming over the internet, it is actually CART unless the text is embedded in a video image and can be “turned on.” How can I use CART in My Elder Law Practice? Speech recognition and comprehension is essential to client communication. In Duvall v. Kitsap County, the Plaintiff described his difficulty in the courtroom as follows: [The Plaintiff] is completely deaf in his left ear and has a severe hearing impairment in his right ear. Because he does not sign well enough to use American Sign Language or Signed English, [his] primary mode of receiving communication is through the written word. He wears custom-fitted hearing aids and is able to communicate effectively in one-on-one conversation in spoken English with the aid of visual cues and lip reading. He finds it extremely difficult, however, to follow a conversation in which he is not a participant. In such circumstances, he is unable to focus on a single speaker to study his facial expressions, body language, and lip movement; nor is he able to control the pace of the conversation, nor provide for a pause that would give him time to process the various aural and visual cues and interpret the speaker’s message.

Attempting to overhear or follow a conversation between others requires a great deal of concentration, and after approximately thirty minutes [he] begins to suffer from tinnitus and headaches that further diminish his capacity to understand spoken communication. The Elder Law attorney should be aware of the availability of CART, and how to make arrangements for its use when required by a deaf or hard of hearing client. It is possible that Page 7 the client would not know such a service exists, and would not know to request it. While now generally accepted as reasonable accommodation in a courtroom setting, your particular courthouse might not be familiar with CART providers, or the Court’s need to provide this service. In a courtroom setting, this service should be provided free of charge for the consumer. In a client meeting, the cost of CART would have to be negotiated among the parties. In a mediation or multi-party meeting, for example, it might be reasonable for all of the parties to share in the cost, so that the hard of hearing individual could fully participate. If you give presentations to market your practice, it would be wise to consider providing CART, displayed on a screen. Even if your target audience members are not seniors, hearing loss affects the entire population. In a recent article in the Journal of the American Medical Association, the scientists report that the portion of U.S. adolescents aged 12 to 19 with any hearing loss rose from 14.9 percent during the 1988 to 1995 period to 19.5 percent in 2005 and 2006.

Here are a couple of tips for preparing for your CART session:

  • Meeting: Provide agendas, handouts, speeches or other material beforehand to enable the CART provider to become familiar with the presentation and prepare for the assignment. Seat the CART provider in the same location as the consumer. If you have more than one or two consumers, it may be necessary to project onto a screen.
  • Courtroom: Provide information to the CART provider before the proceedings — i.e., pleadings, deposition word indexes or other documents — to enable the CART provider to become familiar with the case and prepare for the assignment. Seat the CART provider in the same location as the consumer requiring CART, whether at counsel table, the witness stand, jury box or bench.

In addition, you should try to speak directly to the deaf or hard-of-hearing participant. Do not speak through the CART provider. If an answer is required, pause to enable the consumer to read the question on the CART screen so he or she can respond. Only one person should speak at a time. Provide sufficient breaks for the CART provider. Be alert to the fact that the CART provider acts as the “ears” of the consumer. Any whispers, utterances or laughter overheard by the CART provider will be displayed for the consumer.

A good source of information is the National Court Reporters Foundation Communication Access Information Center The primary purpose of the Communication Access Information Center is to provide information of use to people employing or in need of Communication Access Realtime Translation (CART), also known as realtime captioning. The site is sponsored by the National Court Reporters Foundation and supported by the National Court Reporters Association’s CART Task Force. Go to their website for information on what NCRA is doing to increase the number of available CART providers, or to locate a CART provider.

Tips for Speaking with the Hard of Hearing

  • Speak slowly and enunciate clearly. Pause between sentences. Don’t shout.
  • Whenever possible, face the hard-of-hearing person directly, and on the same level. This allows the hard-of-hearing listener to observe the speaker’s facial expressions, as well as lip movements.
  • Don’t continue to speak while turning to look at a computer, or another person in the room.
  • Be sure to get the attention of the person to whom you will speak before you start talking.
  • Avoid abrupt changes of subject or interjecting small talk into your conversation, as hard-of-hearing listeners often use context to understand what you are saying.
  • If you know (or if it becomes evident) from which side the person hears best, talk to that side. Persons with hearing impairment can also benefit from seating themselves at a table where they can best see all parties (e.g. from the *end* of a rectangular table).
  • Reduce background noises when carrying on conversations. This might include noise from radios, television, computer speakers, printers, ventilation systems, or other conversations.
  • Avoid setting up a meeting in a room with poor acoustics or high levels of background noise. Hearing aids amplify the ambient noises.
  • Make sure the room is well lighted, and that the light is not shining into the eyes of the hard-of-hearing person.
  • If it’s difficult for a person to understand, find another way of saying the same thing, rather than repeating the original words.
  • A woman’s voice is often harder to hear than a man’s, because of its pitch. A woman might try to lower the pitch of her voice to see if that helps.
  • If the hard-of-hearing person wears a hearing aid, make sure that it has batteries installed, the batteries work, the hearing aid is turned “on” and that the hearing aid is clean and free from ear wax.
  • If the person does not understand, rephrase the remark rather than just repeating. Say: “M as in Mary”, “2 as in twins”, “B as in Boy”, and say each number separately, like “five six” instead of “fifty-six,” etc.
  • Recognize that hard of hearing people hear and understand less well when they are tired or ill.
  • Many hard-of-hearing are embarrassed that they can’t hear. They may not volunteer that they did not hear you or understand what was said.