ASL Crisis Lines (24/7)
- 321-800-DEAF or 321-800-3323 DeafLEAD 24-Hour Crisis Line
https://www.deafinc.org/deaflead/24-hour-crisis-line-for-the-deafhh.html
- 1-800-985-5990 Disaster Distress Helpline
https://www.samhsa.gov/find-help/disaster-distress-helpline
- 988 can be texted to reach the National Suicide Prevention Line
Interpreter Resources
"As you might imagine, it is impossible for a clinician to assess, diagnose, and treat language dysfluency in a patient who speaks a language that is different from theirs without the assistance of a skilled interpreter. How can the clinician know that something is odd about the patient's language if the clinician can't understand that language in the first place? The interpreter must bring such information to the clinician's attention, or they will never know. This responsibility may seem a bit scary, but it is a very real aspect of some mental health interpreting situations and, if you are well prepared, your skills can be of tremendous value to clinicians working with dysfluent patients." (Pollard, 1998, p.89)
Pollard, R.Q., Jr. (1998). Mental Health Interpreting: A Mentored Curriculum. University of Rochester.
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My interpreter colleagues! I lovingly dedicate these resources to you.
As a result of the time I spent in my practicum in the Mental Health Interpreter Training (MHIT) Program with the Office of Deaf Services for the State of Alabama, I have a more complete understanding of the skills needed to work effectively in this setting as well as the damage I can do with my uneducated but well-intentioned decisions.
Here are some of my key learnings that have forever changed how I work in mental health:
* Pre and post-conference sessions with the provider are CRITICAL to supporting the therapeutic goal. In other settings it can be considered inappropriate to align with the non-signing participant because of the power dynamics and the potential for us to learn information that isn't ours to know; however, I now know that I CANNOT DO MY JOB if I am going blindly into a mental health setting.
* The three most important things I can find out from the clinician are: 1) Cause of deafness /age of onset, 2) Educational background of the patient/client, and 3) Diagnoses up to this point because I can then make educated guesses about the client's Fund of Information (knowledge of how the world works) and their proficiency with language. Knowing this I can then request to make appropriate expansions/clarifications and be transparent with the provider about why I am making the request. This transparency helps the professional understand their client better and also gives the client greater access because I can meet their linguistic needs. It also benefits the client to a greater extent because it allows the mental health provider to use THEIR skills and training to increase the health of the client.
In addition to the three questions above, it is also helpful to know what model the clinician operates under (if it is counseling/therapy) so that I can anticipate if a guided meditation is coming up or if the provider intends to sternly challenge unhealthy beliefs the client has about themselves. In some approaches, connecting the client with their peers is part of the treatment plan so knowing this ahead of time helps us make intentional choices that align with the goal of the setting, thus increasing the treatment's impact.
*Transparency is one of the most helpful qualities I can bring to my interpretation. If something seems off, I say so and am specific about it. I don't assume that the provider knows what are typical behaviors for deaf and deablind people and I view education as a part of my job too.
* Finally, I have been empowered to see that I have choices of HOW I interpret and I choose based on the needs of the moment. For example, consecutive vs. simultaneous. First person vs. narrative/3rd person. I have many "tools" available to me and it is my obligation to use them.
*I hope you find these resources of use to you!
If you have the opportunity to attend the MHIT, I highly recommend it.
Other Food for Thought:
- Here's an important paragraph to consider from page 5 of the article Mental Health Interpreting with Language Dysfluent Clients by Crump & Glickman (see link.)
"Clinicians, regardless of their own sign language fluency, who routinely work with deaf people, are not typically trained in language dysfluencies and specifically how causes of deafness may impact language skills. Hearing clinicians, who must rely on interpreters likely not trained in mental health work, are usually not even aware of the interplay of the underlying dynamics involved and may naively trust that the interpreter is conveying all the information necessary. This can be further confounded by adjudging through hearing norms, what information they do receive. The result is inaccurate diagnoses and ineffective treatment (Crump and Glickman 2011; Hamerdinger and Karlin 2003."
- Have you thought of the importance of seeing our profession as a practice profession? This means we don't have to view our profession as being locked into a prescription of "will/won't do"s and "is/is not my job."
~ Here is an example. Think about how a doctor (which is another practice profession) would respond if asked to do something unconventional. She would ponder the request and think about if she has the knowledge and authority to perform what is being requested. If not, she would offer resources and educate the requestor.
*** This is a such an important shift in how we approach our work. Not only does it allow us to meet the needs of our consumers better but it also gives us more decision-making power, which then decreases burnout.
(pdf below)
Dean, Robyn & Pollard Jr, Robert. (2009). Consumers and Service Effectiveness in Interpreting Work: A Practice Profession Perspective. 10.1093/acprof/9780195176940.003.0011.
Interpreters! THIS ARTICLE IS IMPORTANT (written from the Deaf perspective) (image above) https://2axend.com/breaking-the-silence-addressing-mental-health-barriers-for-deaf-professionals/
CLANGING
According to this website, clanging "is a disorganized speech pattern that often appears as a
symptom of schizophrenia. It involves using similar-sounding words
together, even though they don't make sense." It can also be a symptom of bipolar disorder. Consider what clanging might LOOK like for ASL users. (Hint: repetitive handshapes)
Watch the clip above from Season 1 Episode 11 of Homeland to see how clanging can be heard in this character's speech. In the show, this character has received the diagnosis of bipolar disorder.
When we see disorganized communication expressed by our clients, can we find a pattern in what appears disorganized?
Also, here's a paper on Language-Related Symptoms in Persons with Schizophrenia and How Deaf Persons May Manifest These Symptoms printed by Gallaudet University Press
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More Resources....
FREE online training conducted in ASL (see above): https://www.youtube.com/watch?v=GrEeVhY0dfY
- GOLD! This online resource is absolute GOLD for interpreters. It's called the ASL-STAR (American Sign Language: Screeners, Tests, Assessments, and Resources) and was developed as a result of a grant by Wright University in Ohio. To learn how it was created and how to use it, you can watch this presentation by Deb Guthmann: https://www.youtube.com/watch?v=d_f4NeqpuZI
ASL-STAR website: https://www.sardiprogram.com/ASLStar/
We, as interpreters, can create an account for ourselves and create a fictitious "client" so that we can order assessments for them and then watch the interpretations for ourselves. There are 10 screeners, tests, and assessments for mental health, substance use, VR, and career interests that have been translated into ASL through a rigorous process.
Providers are able to use this site free of charge and it is HIPAA-compliant. There are also resources for providers who might not be familiar with the Deaf Community and each of the assessments has an accompanying printable version of the tool that is considered more Deaf-friendly. SERIOUSLY. Check this resource out!
The book below has been highly recommended to navigate the professional process of determining our individual roles in EACH SETTING, which is unique to any given day and any given client. This is progressive thought for the current rhetoric in our profession but extremely important for mental health interpreting.
- Here is a free introductory online psychology textbook to further our learning (Psych Web): https://www.psywww.com/
- The LEADER in training interpreters and setting best practice standards in mental health interpreting: MHIT https://mhit.org/
- CALI (Center for Atypical Language Interpreting) https://www.northeastern.edu/cali/
- A video from the state of Michigan that can be shared with practitioners and contains a lot of helpful information https://youtu.be/Mefucn188pk
- Reasons why DIRECT COMMUNICATION is best during times of crisis:
(It can also be found at this website: https://users.neo.registeredsite.com/2/1/4/12973412/assets/NASMHPD_Recommendations_on_988_and_Deaf_Crisis_Services.pdf)
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Page 2 outlines several critical reasons why crisis conversations are best approached with direct communication.
The section "Why Not Interpreters?" is very important also. Here are a few points:
complex interplay of language dysfluency and clinical symptomology."
- Seating arrangements
- Tips for working with interpreters
- Reasons for not using family members or friends to interpret
- Here's an informative article by Hamerdinger and Karlin that explains how our skill level can negatively impact the therapeutic benefit of treatment (via interference and/or distortion):
- What is empathy fatigue and how to avoid it: Harvey, Michael A. "Shielding Yourself from the Perils of Empathy: The Case of Sign Language Interpreters," Journal of Deaf Studies and Deaf Education (April 2003), 207-213, https://bit.ly/Harvey-empathy
- Tips for interpreters working with Deaf-Blind consumers: (American Association of the Deaf-Blind) https://www.aadb.org/information/interpreting/tip_for_interpreters.html
- Tips on how to communicate with people who are DeafBlind https://www.deafblind.com/tipsdbp.html
- John Lee Clark's hugely important articles about social justice concepts when working with the DeafBlind Community (Distantism, for example) https://johnleeclark-blog.tumblr.com/post/163762970913/distantism
- ProTactile Language! A database of resources from Western Oregon University
https://digitalcommons.wou.edu/dbi/ - ProTactile Language Interpreting website:
https://www.protactilelanguageinterpreting.org/resources.html
- Signs and Symptoms of Abuse and Neglect from the Child Welfare Information Gateway:
Therapeutic Approaches in Counseling:
Some counseling approaches emphasize analyzing the past to understand our present choices while others are more action-oriented and thus focus more on taking responsibility for the choices we make daily. Some providers, in aligning with their theoretical approach, might gently validate a client's beliefs while others might forego the grace and instead directly hold the client responsible for their choices.
It is important for us to know their approach before we begin interpreting so that our interpretations aligns with their therapeutic goals and demeanor. (For example, if it's an option that the clinician might yell at the patient, wouldn't you like to know that beforehand so that you can be prepared?)
Here are some resources to introduce you to a few approaches. I have personally seen a lot of Behavioral Therapy (which includes CBT and DBT) being used in the Pacific NW.
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Behavioral Therapy (includes CBT, which includes DBT)
DBT (Dialectical Behavior Therapy)
https://www.verywellmind.com/dialectical-behavior-therapy-1067402
Key features:
It is a kind of CBT (Cognitive Behavioral Therapy.)
Notice, name, and change the emotion (emotional regulation.)
Clients collaborate with therapist on how to change the stress.
Use mindfulness/guided meditation to live in the moment.
Distract and self-soothe to face stress.
The therapist validates.
CBT (Cognitive Behavioral Therapy)
https://www.verywellmind.com/what-is-cognitive-behavior-therapy-2795747
(**Also! See the Glickman book in the resources section. It's a pre-session workbook that teaches the concepts clients need to understand in order for CBT to be effective.)
Reality Therapy
https://www.healthline.com/health/reality-therapy
Key features:
Behaviors are choices.
We make these choices to fulfill needs in 5 basic areas: survival, love/belonging, power/achievement, freedom/independence, fun/enjoyment.
Rejects the idea of mental illness and focuses on the present moment and choices we make.
Take responsibility for our choices and then make different ones.
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When does mental health interpreting come up?
Answer: Anytime! Everywhere!
Here's a slide taken from Dr Jamie Wilson's workshop on Comorbidities 4/20/23
(Synopsis of workshop to follow. Permission was given share this slide.)
Epocrates: Digital resource/app. Pill identifier
Website: National Institute of Mental Health
(describes categories of medications)
https://www.nimh.nih.gov/health/topics/mental-health-medications/#part_149855
Website: Prescriber's Digital Reference
(gives information about specific medications):
Facebook page for Deaf YES: a center for Deaf empowerment
Interpreting for Children with Trauma
I highly recommend taking the 3-part webinar on Trauma Informed Interpreting with Children presented by Andrea Bright-Fontana (https://www.andreabf.com/) and Jon Bergeron (https://www.jonbergeronphd.com/about).
Here are some of my key takeaways from the training:
* Trauma can impact kids by causing the following: learning & attention problems, impaired impulse control, sensory issues, attachment & relational difficulties, emotional dysregulation, and aggressive/self-destructive behavior.
* Neglect can: stunt physical growth, cause cognitive delays and executive functioning deficits, poor self regulation (emotions and energy/arousal), disrupt their stress response (ie chronic stress hormones in system)
* Helpful adjustments when interpreting, as well as considerations:
- Slow down, check in more (not just yes/no and don't rely on the Deaf Nod!), if fingerspell make sure you have already expanded on the meaning, show pictures, provide a limited number of options, repeat info, be careful of facial expression (esp. if anger-based), gesture, have patience! (processing during emotions takes longer), avoid touch, be aware of triggers and communicate them to the appropriate, confidential people
- Kids can have flashbacks which shut them down or cause a strong emotional response. Triggers could be a scent, a person's glasses or clothes, a hairstyle, a phrase, a place, etc. Look for signs of change in demeanor and communicate that to the practitioner. ("This is the interpreter speaking. I noticed when we started talking about XYZ, their demeanor changed.") Don't assume the professional is tracking their expression as much as we are. They could also be taking notes.
- Abuse & neglect change brain structure and function! Don't assume a person's behavior is a "bad attitude." Have compassion and ask yourself, "What can I do to make the information accessible to them?"
- Consider the powerful applications of working with a CDI
- Remember: Kids can make progress but don't forget that they can backslide when dysregulated. You'll need to make adjustments to your work when that happens.
- How do you present yourself? Are you friendly and approachable? Are your clothes appropriate to the setting? (as in, avoid looking overdressed and therefore intimidating.)
- Build rapport with family members and communicate a team mentality. Work with them! They know more about their family member than you do. It's also important to build rapport with the child, in a way much different than working with adults.
- Pre-conference with the provider
- Consider how you can support the child in learning how to advocate for themselves (Ex: How to ask for clarification. They may not want to draw attention to themselves, which brought trauma in the past.)
- Eye contact may be extremely difficult for a young person who has experienced trauma. Be willing to accept that they can only watch you through their peripheral vision.
- There is so much more in the training but the final takeaway I will leave here is be sure to clarify to whom they are referring. For example, is "MOM" their biological mom? Foster mom? Grandmother?
- You can download the PDF below for the Child Welfare Information Gateway's publication on "Recognizing Child Abuse and Neglect: Signs and Symptoms"
Here is Andrea Bright-Fontana's page of RESOURCES/articles about working with children in the foster care system:
Research Regarding Insufficient Provision of Interpreters
Here's
a sobering study about how lack of access to communication causes
health care associated trauma and the rates of unmet needs across the country.
(see visuals below)
"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
Want to learn more? Check these sites for trainings!
For information about Atypical Language: https://cssh.northeastern.edu/cali/
- These are great! If you are curious to learn more about mental health and Deafness, there are videos on this YouTube channel: https://youtube.com/@odsstaff7713 (screenshot below)
- Need a resource to help providers understand how Deaf, DeafBlind, and hard of hearing people have historically experienced the health care system? Give them the link for VITAL SIGNS! (30 min long) https://youtu.be/xr-mlkuTBa4?si=RCzzdxlx8JuFdKZb