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: Fax: VP: TTY: Website:

The Numbers 1990 – 32 Million people in the United States spoke an language other than English 2005 – 52 Million People speaks an language other than English % of the population in Maryland identified as deaf or hard of hearing Source: Prepared by: Maryland Department of Budget and Management, 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. five_n_ html?view=print&comm_ref=false

People who are Deaf or Hard of Hearing Religion Age Gender $$$ Race Deaf deaf HoH CI Latened Congenital Deaf Families Deaf Deaf Blind Social Language/Mode of Communication

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 Different Identities – Different Needs

“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

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 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

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 24 Hour VideoPhone Line 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

..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 Issues to think about: Eye Contact Transference/Counter-transference Relationship building Impact on group and family dynamics

Never look for a psychological explanation unless every effort to find a cultural one has been exhausted -Margaret Mead quoting William Fielding Ogburn