General Information for Clinicians

• This is a wonderful video that shares information regarding Deaf, DeafBlind, and hard of hearing patients, but also perspectives on how they have  experienced health care historically. https://youtu.be/xr-mlkuTBa4?si=RCzzdxlx8JuFdKZb (See image below)
• If you've never worked with someone from the Deaf Community, this is an important synopsis of Deaf Cultural norms : https://vawnet.org/sc/etiquette
  

• A nice general overview: https://www.psychiatrictimes.com/view/psychiatric-assessment-people-who-are-deaf-or-hard-hearing 
  
• National Association of the Deaf's Position Paper on Mental Health Services for Deaf Children https://www.nad.org/about-us/position-statements/position-statement-on-mental-health-services/
• If a deaf child's family doesn't become fluent in sign language, this can be associated with severe behavioral difficulties, poor emotional regulation, and symptoms of depression in the child (p.2) This can manifest as depression/anxiety and chronic diseases (diabetes, hypertension, heart disease, and lung disease) as they become adults.  https://www.ajpmonline.org/article/S0749-3797(20)30214-2/fulltext
  

VERY helpful article:

Neil Glickman, Do You Hear Voices? Problems in Assessment of Mental Status in Deaf Persons With Severe Language Deprivation, The Journal of Deaf Studies and Deaf Education, Volume 12, Issue 2, Spring 2007, Pages 127-147, https://doi.org/10.1093/deafed/enm001 (see below)

Thoughts about lip reading....

"We don't need an interpreter. They'll just read my lips."

As a mental health service provider, minimizing trauma and harm is a strong professional ethic to you. Deaf clients have a history of being told they will not be provided a sign language interpreter.

Please consider the following information when tempted to ask your client to rely on lipreading:

• The adept lip reader only catches 30-40% of the message (https://www.ndcs.org.uk/information-and-support/language-and-communication/spoken-language/supporting-speaking-and-listening/lip-reading/)
• An exercise: Ask someone to say the following words and look for any differences on their lips -- "Baby, Make Me, Pay Me" or "Mom, Mop, Bob, Prom"
• Reading lips involves a lot of guessing and requires a large amount of energy to pair the guesses to make sense. This can cause many misunderstandings, as well as distract from the goal of the session.
  

"We'll just write notes to communicate....."

***(Thank you to Vancro's Jessica Hutchins for sharing her insight on lipreading and written communication.)

Website (photo above) about providing "appropriate, effective quality health care services":  

https://www.nad.org/resources/health-care-and-mental-health-services/health-care-providers/questions-and-answers-for-health-care-providers/

Important article about mental health barriers written by a Deaf author (see image above)

https://2axend.com/breaking-the-silence-addressing-mental-health-barriers-for-deaf-professionals/

More Resources.......

This video that gives a nice overview of communication needs. It was made in Michigan but has a lot of transferable information, no matter where you live: https://youtu.be/Mefucn188pk

The American Sign Language: Screeners, Tests, Assessments, and Resources (ASL-STAR)

https://www.sardiprogram.com/ASLStar/

This resource is GOLD for providers! It is free, research-based,  and HIPAA-compliant.

It's a good starting point to gather more reliable, valid data to make your clinical decisions. It contains 10 screeners, tests, and assessments that have been translated into ASL and vetted for accuracy and consistency. (Keep in mind, if a client is Language Dysfluent more accommodations will likely need to be made.)

Here is a lecture detailing its creation and intent: https://www.youtube.com/watch?v=d_f4NeqpuZI

** This is not a substitute for having full access to language with the client. These questions may spark interest or trigger a painful memory so having an interpreter there as well supports you being able to elaborate or clarify important points.

Here's a sobering study about how lack of access to communication causes health care associated trauma and the prevalence of this damaging gap. 

"Most health care providers, including mental health providers, are inadequately prepared to meet the needs of DHH (Deaf and Hard of Hearing) American Sign Language users. They lack knowledge of DHH people's culture and language, including their values and social norms, as well as the systems of oppression that DHH people face. This disconnect between many clinicians and DHH clients contrigutes to mistrust that can weaken a patient's ability to seek help and stay in treatment. Repeated encounters with these barriers justifiably fuel negative perceptions and avoidance of the mental health care system, frequently resulting in delayed treatment, misdiagnoses, inappropriate treatment, exacerbation of mental health problems, and increased length of stay." https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.00408

Below are downloadable PDFs that explain a variety of introductory topics:

American Sign Language ~

Deaf Culture ~

Deaf Identity~

Page 30 of this website is below: 

https://www.nctsn.org/resources/addressing-trauma-treatment-needs-children-who-are-deaf-or-hard-hearing-and-hearing

Laws & Regulations ~

Working with Deaf children ~

1.  Roberts, C., & Hindley, P. (1999). Practitioner Review: The Assessment and Treatment of Deaf Children with Psychiatric Disorders. Journal of Child Psychology & Psychiatry & Allied Disciplines, 40(2), 151. https://doi-org.libproxy.pcc.edu/10.1111/1469-7610.00430

2. Addressing the Trauma Treatment Needs of Deaf Children: (Great resource!)

https://www.nctsn.org/sites/default/files/resources//addressing_the_treatment_needs_of_children_deaf_hard_of_hearing_hearing_children_deaf_parents.pdf

3. Facts on Trauma and Deaf Children: 

https://www.nctsn.org/sites/default/files/resources//facts_on_trauma_deaf_children.pdf

This document gives introductory information about a variety of topics pertaining to Deaf people~

https://mh.alabama.gov/wp-content/uploads/2019/01/ODS_MeetingTheMentalHealthNeedsOfPersonsWhoAreDeaf.pdf

What is a Certified Deaf Interpreter?

Working with a CDI can often be beneficial in mental health settings. I like this agency's introduction to CDIs (disclaimer: I do not know them and they are not local) 

https://www.stratusvideo.com/certified-deaf-interpreters-essential-healthcare/

When working specifically with deafblind clients/patients~

• Communicating with a deafblind client takes longer because the client likely has to feel the interpreter (tactile sign language), which is a longer process.  Alternatively, some clients require close vision of the interpreter, as opposed to touch. The lighting in the room may need to be adjusted also.
  
• The interpreter will likely need to describe the visual information in the setting (who is present, what the room looks like, etc) in order to build trust and increase the client's feeling of safety.    
  
• When preparing for a visit with a deafblind client, it is helpful to prioritize your goals and communicate that to the interpreter so they can align their communication choices with your goals. This will provide you with more applicable data and allow them to support your treatment plan and strengthen your diagnosis.

• NELSON, C., & BRUCE, S. M. (2016). Critical Issues in the Lives of Children and Youth Who Are Deafblind. American Annals of the Deaf, 161(4), 406-411. https://doi-org.libproxy.pcc.edu/10.1353/aad.2016.0033 (pdf below)
  

• ARNDT, K., & PARKER, A. (2016). Perceptions of Social Networks by Adults Who Are Deafblind. American Annals of the Deaf, 161(3), 369-383. https://doi-org.libproxy.pcc.edu/10.1353/aad.2016.0027 (pdf below)
  

• FAQ section of American Association of the Deaf-Blind website https://www.aadb.org/FAQ/faq_DeafBlindness.html
  

Amazing RESOURCES about ProTactile Communication, which is a contemporary and progressive movement in the DeafBlind Community. One tenet of the movement is the necessity and right to TOUCH. Read more below!!

https://digitalcommons.wou.edu/dbi/