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Deaf Mental Health Research: Where We've Been and Where We Hope to Go

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Deaf Mental Health Research: Where We've Been and Where We Hope to Go

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... Given that most Deaf clients who enter behavioural health treatment have trauma histories and at least 74% of Deaf individuals in SUD treatment have experienced abuse (Titus et al., 2008), implementing integrated trauma/SUD interventions for this population is a logical first step to address Deaf behavioural health disparities in the United States. However, currently available evidence-based psychotherapies were designed for hearing populations and therefore fail to meet the unique linguistic, developmental, and cultural needs of Deaf clients (Anderson et al., 2017b;Estrada & Beyebach, 2007;Fellinger & Fellinger, 2014;Glickman & Pollard, 2013;Kuenburg et al., 2016;Skot et al., 2017). Most combine traditional talk therapy with client workbooks or handouts, which often contain sophisticated strategies for tracking mood, behaviour, and thoughts, and use psychological jargon throughout. ...
... At the time of this publication, there have been no large-scale behavioural clinical trials conducted with Deaf signing people and, therefore, there are no evidence-based psychotherapeutic treatments that have been formally validated for this unique population (Anderson & Wolf Craig, 2018;Estrada & Beyebach, 2007;Fellinger et al., 2012;Glickman & Pollard, 2013;Munro et al., 2008;NASMHPD, 2012). In the United States, there have been many descriptive accounts of how to best serve Deaf therapy clients who use ASL and there is an emerging consensus regarding some best ...
... However, such implementation has typically occurred when most of the clients in a counselling group are able to read, and just one or a few are unable to. Moreover, Seeking Safety's client materials are in written English, and, therefore, do not target the unique needs of many signing Deaf clients (Anderson et al., 2016;Glickman & Pollard, 2013). The Signs of Safety toolkit was designed to overcome these barriers via a supplemental counsellor guide and Deaf-accessible client materials, as described below. ...
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The U.S. Deaf community – more than half a million Americans who communicate using American Sign Language (ASL) – experiences higher rates of trauma exposure and substance use disorder (SUD) than the general population. Yet, there are no evidence‐based treatments for any behavioral health condition that have been evaluated for use with Deaf people. The driving aim of our work, therefore, has been to develop and formally evaluate a Deaf‐accessible trauma/SUD counseling approach. Here we describe our initial intervention development work and a single‐arm pilot that evaluated the feasibility, acceptability, and preliminary clinical efficacy of Signs of Safety ‐ a Deaf‐accessible toolkit to be used with an existing, widely adopted protocol for trauma and addiction (Seeking Safety). Preliminary efficacy results indicated clinically significant reductions in PTSD symptoms and frequency of alcohol use for the Seeking Safety/Signs of Safety model. Frequency of drug use did not change significantly ‐ likely attributable to the mid‐study legalization of recreational marijuana in our state. Next steps include the redesign and refilming of Signs of Safety based on pilot participant feedback, again using a Deaf‐engaged development and production process. This new toolkit will be tested via a pilot randomized controlled trial designed based on present methodological lessons learned.
... Caselli et al. (2020) distinguish between the value of K-12 interpreters when a student is proficient in sign language versus the harm that can be caused when presuming that interpreters are an appropriate accommodation for deaf students who arrive in elementary education settings without proficiency in sign language. The authors argue that this common situation aggravates the "language deprivation" problem (see Hall et al., 2017 andGlickman &Hall, 2018) that these students contend with when their primary or only sign language model is an interpreter. SLIs cannot serve as an interpreter for a child lacking in sign fluency nor function as a formal sign language instructor for the child with any real effectiveness in either respect. ...
... We call for a "consensus planning conference," common in the sciences, even in the deafness field (e.g., Glickman & Pollard, 2012;Pollard, 1995). Such conferences take place when disclarity or differences of opinions exist regarding a particular, important issue, and there is a sufficient body of scientific literature to potentially move a field forward past a state of disunity or divisiveness. ...
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Cumulative motion injuries and burnout contribute to an international shortage of signed language interpreters (SLIs). Studies using the Job Content Questionnaire, a well-validated measure of occupational health risks, indicate that risk levels differ among SLI work settings. Specifically, video relay service (VRS) and primary and secondary educational settings (K–12) are associated with greater health risks. The current study validated those results by analysing the diurnal rhythm of salivary cortisol levels. Anomalies in diurnal cortisol rhythms are associated with an array of health problems. Our full-time SLI participants included VRS workers ( N = 20), K–12 workers ( N = 18), and SLIs who worked in other settings ( N = 23). Non-interpreters using sign language daily at work ( N = 18) comprised a fourth group. Saliva samples were collected four times daily over 2 working days. The VRS and K–12 SLIs demonstrated lower morning peak cortisol levels and flatter diurnal cortisol slopes from morning peak to subsequent diminution. Both findings are associated with chronic stress and greater health risks. The VRS and K–12 groups’ diurnal cortisol patterns closely resembled each other, while the Other SLI group’s curve closely resembled that of the Non-Interpreter group. Implications for SLI health, education, and job redesign are discussed in the context of the demand control schema.
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Psychological assessment plays a large part in the practice of psychology. Over the years, steps have been taken towards ensuring ethical and culturally sensitive psychological assessment for underserved populations, but little is known about the current state of the field of assessment of deaf and hard-of-hearing (DHH) individuals. An exploratory survey of school and clinical psychologists who work with DHH clients (n = 30) was conducted to obtain a snapshot of the state of the field. The current article focuses on sociodemographic characteristics, clinical training, clinical experiences, and language abilities of clinical psychologists who work with DHH clients. Participants averaged 15 years of assessment experience and almost all participants had some type of specialized training in assessing DHH clients. More than half of participants reported their ability to use multiple languages and communication approaches as either excellent or good. Current findings were compared with a similar survey from nearly 50 years ago (Levine, E. S. (1974). Psychological tests and practices with the deaf: A survey of the state of the art. Volta Review, 76, 298-319), and significant differences were found in participants' self-reported experience with DHH clients, training, and methods of communication.
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Although many studies have examined deaf people's lived experiences of audism in various contexts, relatively little research has examined such experiences in the area of employment, particularly in Ireland. This gap is compounded by the fact that deaf people continue to experience employment discrimination and there is a dearth of research focusing on underlying causes of discrimination. The term "audism" has been widely used in deaf studies literature to describe a set of assumptions that promote the unequal treatment of individuals on the basis of hearing (dis)ability. In this study, I use qualitative analysis of interviews with 8 deaf adults to examine the impact of audism on the lived experience of employment discrimination. My main objective was to examine the effect and cause of discrimination which prevent access to employment opportunities. The findings indicate that the three levels of audism-individual, institutional and internalized-had the effect of creating blocks and barriers to employment opportunities for deaf people. The results also point to stigma, stereotyping and prejudice as underlying causes of discrimination. The study concludes by discussing the implications of the results for conceptualizations of discriminatory behaviours on the part of employers.
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This study was aimed at validating the Individual Recovery Outcomes Counter (I.ROC) for deaf, hard-of-hearing, and tinnitus patients in a mental health care setting. There is a need for an accessible instrument to monitor treatment effects in this population. The I.ROC measures recovery, seeing recovery as a process of experiencing a meaningful life, despite the limitations caused by illness or disability. A total of 84 adults referred to 2 specialist mental health centers for deaf, hard-of-hearing, and tinnitus adults in the Netherlands completed the Dutch version of I.ROC and 3 other instruments. A total of 25 patients refused or did not complete the instruments: 50% of patients using sign language and 18% of patients using spoken language. Participants completed the measures at intake and then every 3 months. In this sample I.ROC demonstrated good internal consistency and convergent validity. Sensitivity to change was good, especially over a period of 6 or 9 months. This study provides preliminary evidence that the I.ROC is a valid instrument measuring recovery for hard-of-hearing and tinnitus patients using spoken language. For deaf patients using sign language, specifically those with limited language skills in spoken and written Dutch, more research is needed.
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One of the most understudied health disparity populations in the United States is the Deaf community, a sociolinguistic minority group of more than 500,000 individuals who communicate via American Sign Language. Research on Deaf health disparities is lacking due to inaccessible recruitment, sampling, and data collection procedures, as well as the fundamental disconnect between medical and cultural views of Deaf people. A potential starting place for addressing inaccessible research methods and mistrust of the biomedical research community is the careful reconsideration of the traditional informed consent process, often a Deaf individual's first point of contact with the research world. Yet, most Deaf individuals experience obstacles to engaging in informed consent due to differences in language and development compared to hearing individuals. In response to these issues, our team led a three-phase, formative, community-engaged approach to adapt the informed consent process and train research staff in the updated method so that all required components are properly communicated and understood. The goals of our work were to promote Deaf engagement in research about the Deaf community, increase the number of Deaf individuals who participate in general population biomedical research, and generalize our findings to improve research accessibility for the general population.
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This chapter will focus on the factors that contribute to the health inequities of a unique, liminal community, namely the Deaf community. Defined as a minority community, both by language and by culture, members of this community experience health inequities differently from other minority communities. Research indicates that Deaf people find it more difficult to establish relationships with health and allied professionals, and to access mental health services because of discrimination, lack of understanding, and practical obstacles experienced within the health system. It is further reported that 80–90% of Deaf and hard of hearing people with severe and persistent mental illness are not accessing mental health services. The literature suggests a higher prevalence of mental health problems for those who are culturally Deaf than in the general population. The most common factor preventing access to services, including assessment, intervention, and follow-up, as well as to mental health prevention materials is inadequate communication. This chapter will explore how a unique form of oppression that relates to the oppression by hearing people of those who are deaf (i.e., audism, the notion that one is superior based on one’s ability to hear or behave in the manner of one who hears), results in health and mental health care disparities. The chapter will conclude with a discussion on recommended practices to facilitate effective engagement with members of this minority culture.
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Forensic inpatients who experience hallucinations and delusions present with complex clinical needs, which can be exacerbated through additional individual difficulties and disabilities impacting responsivity. Experiences of hallucinations and delusions are shaped by the individual’s context and culture; however, to date this has not been explored with regards to the experience of deaf persons. The current study employed Multiple Sequential Functional Analysis to conceptualize the developmental nature of hallucinations and/or delusions in a sample of three Deaf men from a secure specialist Deaf service. No evidence was found of unique experiences shaping the content and themes of hallucinations; however, participants reported a learning history of associating deafness with being inferior, which later emerged in delusions of grandeur. Across all three cases, there was a noticeable lack of clinical information available in case notes and a lack of targeted interventions offered by forensic service providers.
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D/deaf individuals are often marginalized in our society. A lack of cultural understanding among social workers serving this population, coupled with communication barriers, inconsistent access to interpreters, or misperceptions of culture, adds to the potential for further marginalization. D/deaf individuals seeking mental health and social services live in a unique cultural context with which social workers may not be familiar and experience persistent issues surrounding access to mental health and social services. This article reviews some useful best practices, cultural points to be aware of, and suggests some strategies for providing culturally responsive social work when working with D/deaf clients.
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Resilience in the face of trauma is an important yet elusive construct in human development. While there are prevalent data suggesting high rates of trauma among deaf individuals, valuable insight on how resilience evolves among deaf individuals within the context of trauma has yet to be explored sufficiently. This study explored the concept of resilience through semi-structured interviews with a total of 19 experienced mental health providers. Using an applied thematic analysis approach, the following five themes were identified as crucial protective factors in resilience processes: individual assets, identity development, access to language and communication, access to information, and supportive networks. Findings both confirm previous findings about resilience as well as identify unique protective factors for deaf individuals with trauma. The discussion explores those protective factors and their role as resources for social services professionals and deaf individuals in efforts to support resilience.
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We view interpreting as a practice profession, like medicine, law, teaching, counseling, or law enforcement, where careful consideration and judgment regarding situational and human interaction factors are central to doing effective work. We contrast the practice professions with the technical professions, such as engineering and accounting, where knowledge and skills pertaining to the technical elements of a job are largely sufficient to allow the professional to produce a competent work product. Interpreters function more like practice professionals than technicians due to the significance of situational and human interaction factors on their ultimate work product; that is, factors beyond the technical elements of the source and target language (Dean & Pollard, 2001; Gish, 1987; Humphrey & Alcorn, 1995; Metzger, 1999; Roy, 2000a; Wadensjo, 1998). Interpreters cannot deliver effective professional service armed only with their technical knowledge of source and target languages, Deaf culture, and a code of ethics. Like all practice professionals, they must supplement their technical knowledge and skills with input, exchange, and judgment regarding the consumers they are serving in a specific environment and in a specific communicative situation (see both Turner and Winston, this volume). (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Children acquire language without instruction as long as they are regularly and meaningfully engaged with an accessible human language. Today, 80% of children born deaf in the developed world are implanted with cochlear devices that allow some of them access to sound in their early years, which helps them to develop speech. However, because of brain plasticity changes during early childhood, children who have not acquired a first language in the early years might never be completely fluent in any language. If they miss this critical period for exposure to a natural language, their subsequent development of the cognitive activities that rely on a solid first language might be underdeveloped, such as literacy, memory organization, and number manipulation. An alternative to speech-exclusive approaches to language acquisition exists in the use of sign languages such as American Sign Language (ASL), where acquiring a sign language is subject to the same time constraints of spoken language development. Unfortunately, so far, these alternatives are caught up in an "either - or" dilemma, leading to a highly polarized conflict about which system families should choose for their children, with little tolerance for alternatives by either side of the debate and widespread misinformation about the evidence and implications for or against either approach. The success rate with cochlear implants is highly variable. This issue is still debated, and as far as we know, there are no reliable predictors for success with implants. Yet families are often advised not to expose their child to sign language. Here absolute positions based on ideology create pressures for parents that might jeopardize the real developmental needs of deaf children. What we do know is that cochlear implants do not offer accessible language to many deaf children. By the time it is clear that the deaf child is not acquiring spoken language with cochlear devices, it might already be past the critical period, and the child runs the risk of becoming linguistically deprived. Linguistic deprivation constitutes multiple personal harms as well as harms to society (in terms of costs to our medical systems and in loss of potential productive societal participation).
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Deaf and hard-of-hearing individuals develop their identities within environments that convey and reinforce preconceived assumptions of what it means to hear or see the world differently. These assumptions ultimately influence identity evolution and psychological well-being. A Lens on Deaf Identities explores multiple factors, both past and present, with significance for deaf/hard-of-hearing identities. These factors include explanatory paradigms of how deaf and hard-of-hearing people are understood within the context of disability and sociolinguistics; the formal recognition of a Deaf culture and the emergence of bicultural frames of reference; the appearance of deaf identity theories in the psychological literature; the influence of families and schools, and historical and social contexts; the acknowledgment of diversity in this population; and the technology that affects the identity of deaf people in different ways (e.g., cochlear implants as bionic ears, telecommunications that bring deaf people together with each other as well as with hearing people, and advances in genetics that counter the acceptability of hearing differences). Personal experiences, theoretical formulations, and research data are used to examine interfaces within and between each of these areas and how the tensions emerging at these junctures influence deaf and hard-of-hearing identity formation in complex, multifaceted ways that defy pervasive stereotypes of deaf and hard-of-hearing persons. This book will appeal to readers interested in d/Deaf/hard-of-hearing lives, Deaf studies and deaf education, and those interested in identity formation in the presence of "disability".
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The few available studies on the relationship of hearing loss to violence indicate that the prevalence of brain damage, learning disability, communication disorders, educational retardation, unemployment, and underemployment in the deaf and hard-of-hearing population creates frustration which tends to manifest in disproportionate aggression, violence, and hostility. Relative to prevalence, hearing-impaired people are overly represented in the prison population, which is the major datum the literature on violence and hearing loss yields. Other than 12 studies and an American Speech and Hearing Association Committee report documenting the fact, there is an amazing paucity of literature on hearing loss and violence. The reasons for this deficit of information are discussed and ways to remediate the problem are suggested.
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A common theme among writings on intimate partner violence against Deaf women is the concern that there is little empirical work conducted in this field in comparison to research conducted with hearing populations. However, it is important to acknowledge that an increased amount of research has been conducted in recent years and that a foundation of research has been established, on which future researchers can build and expand. The goal of the current review is to summarize and synthesize the recent work in this area, as well as identify remaining gaps and needs for future empirical work. While there are substantial issues and gaps in the current research base, the most critical issue is that of dissemination and networking—many of the studies in the current review remain unpublished, making this information difficult to obtain. As such, it is similarly difficult to locate other investigators in the field, hindering our ability to build on one another's work, as well as develop effective research collaborations. The foundation has been established. The researchers are out there. The next step is to work together to expand our knowledge of intimate partner violence against Deaf women.
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The present study examined domestic violence and perceived social support in a clinical sample of Deaf and Hard of Hearing women. Forty-six adult Deaf and Hard of Hearing females receiving outpatient mental health services completed a modified version of the Conflict Tactics Scale and the Interpersonal Support Evaluation List. Results showed that nearly three-quarters (71.7%) of the sample related experiencing psychologically abusive behaviors, and over one-half (56.5%) reported a history of physical violence from a partner. In addition, participants reported experiences of domestic abuse directly related to their deafness. Level of perceived social support did not differ for participants with a history of domestic violence victimization compared to those with no such history. Findings underscore the need for increased awareness of Deaf and Hard of Hearing women as a population at high risk, and warranting further investigative attention, with regard to domestic violence. KeywordsDomestic violence-Deaf-Hard of hearing-Social support
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It has been estimated that roughly 25% of all Deaf women in the United States are victims of intimate partner violence (Abused Deaf Women's Advocacy Services [ADWAS]), a figure similar to annual prevalence rates of 16% to 30% for intimate partners in the general population. One goal of the present study was to ascertain the prevalence of intimate partner violence victimization in a sample of Deaf female college students. When comparing the prevalence of physical assault, psychological aggression, and sexual coercion victimization to hearing female undergraduates, the current sample was approximately two times as likely to have experienced victimization in the past year.
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The professional literature contains research and anecdotal information on various maltreatments affecting children and youth with and without disabilities. Unfortunately, little information exists on abused children with hearing loss. Reasons relate to a lack of quantity and quality in research on this population; challenges in conducting research using sound methodological principles that consider the population's heterogeneity (e.g., mode of communication, language level, parental perspective on deafness, educational placement); and scarce intervention services with professionals trained in the unique needs of children with hearing loss. The present article discusses types of abuse prevalent within the overall population of children and that of children with hearing loss, shares a rationale for practitioners and those training future practitioners to understand abuse among this unique population, proposes a research agenda based on existing information, and provides suggestions for supporting children who are deaf or hard of hearing and abused.