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Governor’s Office of the Deaf and Hard of Hearing Outpatient Services Program Workgroup Working with Individuals Who Are Deaf or Hard of Hearing June 24, 2014. Voice: 410-767-1497 Fax: 410-333-1016 VP: 443-453-5954 TTY: 410-767-7756 Website : www.odhh.maryland.gov

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slide1

Governor’s Office of the Deaf

and Hard of Hearing

Outpatient Services Program Workgroup

Working with Individuals Who Are Deaf or Hard of Hearing

June 24, 2014

Voice: 410-767-1497 Fax: 410-333-1016

VP: 443-453-5954 TTY: 410-767-7756

Website: www.odhh.maryland.gov

Email: gov.odhh@maryland.gov

the numbers
The Numbers
  • 2003 - 9.25% of the population in Maryland identified as deaf or hard of hearing Source: Prepared by: Maryland Department of Budget and Management, 2003
  • 2012 - Archives of Medicine reports that one in five Americans age 12 and over have hearing loss in at least one ear. This translates to approximately 48 million people.
    • http://nihseniorhealth.gov/hearingloss/hearinglossdefined/01.html
    • http://www.huffingtonpost.com/2011/11/15/hearing-loss-americans-one-in-five_n_1095586.html?view=print&comm_ref=false
  • 1990– 32 Million people in the United States spoke an language other than English
  • 2005 – 52 Million People speaks an language other than English
people who are deaf or hard of hearing
People who are Deaf or Hard of Hearing

Deaf deaf HoH CI Latened Congenital Deaf Families

Deaf Deaf Blind

Religion

Social

$$$

Age

Gender

Race

Language/Mode

of Communication

slide4

Different Identities – Different Needs

Deaf

Cultural and Linguistic Minority

Primary Language: American Sign Language

Cultural Issues

Language Issues

Access Issues

Evidence Based Treatment

Provided in primary language

May require use of an interpreter

deaf or hard of hearing

Not a minority – a disability; Experiencing loss of access to communication

Primary language – English

Access to language limited by hearing challenges

Focus on use of technology and other forms of accessibility

Use of ALD

Text based communications

  • There is a negative impact when there are language discrepancies between counselors and clients
slide5

“Deaf people who use American Sign Language (ASL) are medically underserved and often excluded form health research and surveillance.” American Journal of Public Health – 2011

  • “Deafness is a heterogeneous condition with far-reaching effects on social, emotional, and cognitive development…Increased rates of mental health problems are reported in deaf people. …(There are) discrepancies between a high burden of common mental health disorders and barriers to health care.” Fellinger, Holzinger, Pollard - 2012
behavioral health
Behavioral Health
  • Mental illness and substance abuse represents a much more significant barrier than being deaf or hard of hearing
  • People who are deaf or hard of hearing:
    • Do seek mental health and substance abuse counseling.
    • Experience all of the symptoms of mental illness as their hearing counterparts including mood disorders, psychosis, delusions, hallucinations and auditory hallucinations.
    • Have auditory hallucinations even if they have never heard a sound.
    • Experience problems with addictions to all types of substances and behaviors.
gaps in deaf services
Gaps in Deaf Services
  • Overall Behavioral health Services
    • Underserved cultural and linguistic population
    • Normal adjustment is often mistaken as a developmental delay, mental illness, or mental retardation
    • May be at heightened risk for experiencing abuse and intimate partner violence
  • Crisis Services
    • Not Accessible in consumer’s primary language
    • Access to interpreters by its nature creates a delay which is a significant barrier to crisis response
  • Peer Support
    • On Our Own has provided WRAP training to Deaf consumers
    • No ongoing interpreter funds or support – even when interpreters are present, consumers remain isolated
    • No access to Mental Health First Aid
  • Cultural Barrier
    • Language Deprivation
    • Lack of Sensitivity and Awareness of Cultural Norms
eviden ce based services for deaf and hard of hearing consumers include
Evidence Based Services for Deaf and Hard of Hearing Consumers include:
  • Acknowledgement and emphasis on
    • Direct communication
    • Sensitivity to Cultural Affiliation
    • Sensitivity to Psychological Impact on Delivery Service
      • Mental Health
      • Substance Abuse
      • Cognitive and Developmental Disabilities
  • Public and Private Mental Health
    • A comprehensive and full menu of services
    • Equal in choice & quality to services offered to people who are hearing
needs
Needs
  • 24 Hour VideoPhoneLine
  • Materials available in American Sign Language (ASL) (videos)
  • Information available to consumers in ASL about the availability of service
  • Clinicians and staff fluent in ASL and sensitive to issues of culture when providing duties and services in all capacities of behavioral health treatment including:
    • Intake Appointments
    • Assessment Interviews
    • Treatment Sessions
slide10
..and
  • Recognition and integration of cultural and linguistics needs for Deaf, deaf, hard of hearing and deafblind consumers
  • Mandated referrals to specialized providers fluent in American Sign Language and if unavailable, the coverage of the cost of interpreters
  • Development and provision of professional training resources
mental health treatment with interpreters
Mental Health Treatment with Interpreters
  • Issues to think about:
    • Eye Contact
    • Transference/Counter-transference
    • Relationship building
    • Impact on group and family dynamics
slide12

Never look for a psychological explanation unless every effort to find a cultural one has been exhausted

-Margaret Mead quoting William Fielding Ogburn