Adapting Substance Abuse Treatment for Deaf and Hard of Hearing Clients:

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Adapting Substance Abuse Treatment for Deaf and
Hard of Hearing Clients

• Towards Cultural Competence and Effective
  Community Response
• Michelle Niehaus, LCSW
• Seven Counties Services, Inc.

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Learning Objectives

• Participants will identify barriers to treatment
  and recovery for individuals with hearing loss
• Participants will see examples of adapting
  treatment to meet linguistic needs of Deaf
  clients
• Participants will gain understanding of working
  with members of the Deaf culture
• Participants will learn resources for
  collaboration and ongoing learning with the Deaf
  and Hard of Hearing populations

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What perspective do you start from?

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A Healthy Perspective on Deafness

• Medical View
• Deafness as defect or abnormality.
• Look to fixor cure
• Sign language inferior to spoken language
• Socialization with hearing
• Normal hearing person as best role model
• Professional involvement to overcome loss

• Cultural View
• Difference/cultural minority
• Emphasize abilities
• Sign language as equal to spoken language
• Socialize in and respect Deaf community
• Deaf role models
• Professionals work with the Deaf

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But Thats Not AllOther Dimensions of Diversity
to Consider
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Factors in Deafness Contributing to Substance Use
and Abuse

• Isolation from family and the world
• Feeling different from the mainstream
• Un- or Underemployment
• Lack of acceptance or understanding from society
• Financial cost of adaptive equipment and services
• Lack of equal access to services and society
• Stigma in hearing culture for being deaf
• Feelings of shame since the Deaf community often
  sees addiction as a personal weakness and moral
  sin

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Barriers to Treatment and Recovery

• Recognition of the Problem
• Confidentiality The Grapevine
• Lack of Resources
• Enabling
• Funding Concerns
• Lack of Support in Recovery

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Effective Cross-Cultural Counselors

• communication competence, ability to generate
  new ways of describing the world and adaptability
  to ever-changing situations. The multi-cultural
  person is someone who is adaptive, continually
  in transition, and grounded in his/her own
  cultural reality
• - Fitzgerald and OLeary

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Physical / Communication Accessibility

• How many hours per day are qualified interpreters
  available?
• Are some staff fluent in ASL?
• Are some staff members Deaf or Hard of Hearing?
• Are there other Deaf or HOH clients in the
  program?
• Are TTYs available for client use?
• Do patient rooms have flashing light doorbells?
• Are there videos/DVDs captioned or signed?
• Is there a chaplain available who is
  knowledgeable about Deaf culture?
• Are there treatment materials with options for a
  wide range of client communication abilities?
• Are assistive listening devices available?
• Are there AA/NA meetings accessible to the Deaf?
• Is a communication assessment performed on
  clients?
• Is there a family component to the program?
• Is aftercare planning provided on an individual
  basis?
• Is coordination with VR and Rehab Counselors for
  the Deaf part of discharge planning?

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The Importance of Language

• Language is the key to identifying Deaf culture
• It is the means of inclusion and acceptance or
  exclusion and isolation
• People with hearing loss tend to be Highly
  Visually Oriented (HVO) in receptive and
  expressive communication
• However, there is also a wide range of
  communication skills within the population of
  people with hearing loss each person must be
  assessed individually
• A client should not have to change his/her mode
  of communication to meet the clinicians
  proficiency level while also dealing with a
  variety of other clinical issues. Deb Guthmann

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Working Effectively with Interpreters

• The ADA requires a qualified interpreter. This
  means s/he must be certified by a national body
  (RID, NAD), licensed in Kentucky, and have
  specific knowledge of substance abuse terminology
• Interpreters are bound by their Code of Ethics,
  but it is good practice to keep copies of their
  KY licenses and the SCS confidentiality agreement
  on file.
• Use pre- and post-sessions to get and give info
  on the setting, issues to be addressed, and any
  communication needs.
• The interpreters is NOT a mental health or
  substance abuse professional and cannot give
  opinions on diagnosis or treatment
• Speak directly to the client and do not use tell
  him, tell her, etc.
• In a group setting, be sure to enforce
  turn-taking rules and provide info to members on
  confidentiality
• Do not leave interpreters in situations where
  they are expected to monitor or entertain the
  Deaf client

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When Interpreters Arent Enough

• Some individuals have idiosyncratic or home
  signs difficult for an interpreter to understand
  in a cold situation Certified Deaf
  Interpreters may be needed
• Other individuals know that they have a right to
  direct communication (Tuggs vs. Towery) and want
  signing clinicians
• All modalities of treatment (individual, group,
  medical services, written materials, videos, etc)
  must be accessible and understandable to a client

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Build Awareness of the Following During the
Assessment Process

• Identity as deaf, Deaf, Hard of Hearing, Later
  Deafened
• Language Usage / Mode of Communication
• Family Background
• Educational Background
• Socialization
• Shared Experience of Stigma
• Potential Inferiority Stereotyping by Majority
• History of people ignoring or not understanding
  their inner world or subjective experiences
• History of communication neglect
• Overgeneralization Ive worked with one deaf
  person before

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Adapting Treatment

• Pre-Treatment may be needed to assess a clients
  basic understanding of recovery terms and prior
  exposure
• If a person completed treatment in the past by
  writing, speechreadng, or other means without a
  qualified interpreter, do not count those as
  credible treatment episodes
• Use review, rephrasing, and summarizing to
  confirm understanding
• Make concepts as visual as possible
• Allow for homework to happen in a variety of
  modalities (watching videos, drawing, signing
  into a videocamera rather than writing, etc)
• Consider using role play, rehearsal and other
  experiential means to work with concepts
• Avoid using acronyms or jargon without explaining
  fully. Have the client repeat to check for
  understanding
• Begin discharge planning early since accessible
  resources are not readily available

• Expect treatment to take longer. Go one concept
  at a time so that you are building on a firm
  foundation.
• Hold the individual accountable for his/her own
  actions just as you would a hearing client
• Use interpreters in pre- and post-sessions to
  check for the clients understanding and language
  functioning
• Consult with DHHS with questions regarding
  cross-cultural treatment

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Aftercare Planning

• The Minnesota programs outcome study indicated
  three significant predictors for abstinence in ST
  or LT follow-up
• 1. Employment Status at Follow-Up
• 2. Availability of Family to talk to during
• follow-up
• 3. AA/NA Attendance

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Clinical Resources for Treatment

• Videotape Dreams of Denial
• Videotape Clinical Approaches An American
  Sign Language Interpretation of the Twelve Step
  Program
• Book Clinical Approaches A Model for Treating
  Chemically Dependent Deaf and Hard of Hearing
  Individuals
• Book Staying Sober Relapse Prevention Guide
• The above resources were developed by the
  Minnesota Chemical Dependency Program for Deaf
  and Hard of Hearing Individuals. Their website
  provides additional articles and information
  www.mncddeaf.org

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Increasing Clinical Knowledge of Deafness and
Substance Abuse

• Video from UCSF Center on Deafness Meeting the
  Challenge Working with Deaf People in Recovery
• The Distance Learning Center for Addiction
  Studies offers an online course by Dr. Frank
  Lala. Its available under Multicultural on
  the followng website www.dlcas.com
• DHHS has multiple resources available in the
  forms of books, videos, and individual
  consultation. Please contact Michelle Niehaus at
  589-8910 x126 or mniehaus_at_sevencounties.org

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Resources in the Louisville Area

• Rehabilitation Counselors for the Deaf Craig
  Lemak and Amanda Friend, 410 West Chestnut
  Street, 595-3337 (TTY)
• Case Manager for Homeless in Recovery
• Phoenix Health Center, Susanne Boddie
• Foxhall Meeting (St. Andrews Episcopal Church,
  2233 Woodbourne Ave, 800 p.m.) on Tuesday nights
  ASL Interpretation Always Available

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References

• Guthmann, D. Counseling Deaf and Hard of Hearing
  Persons with Substance Abuse and/or Mental Health
  Issues Is Cross Cultural Counseling Possible?
  Unpublished. Minnesota Chemical Dependency
  Program for Deaf and Hard of Hearing Individuals.
  www.deafhealth.net/cd/cd2.htm. Retrieved
  8/23/99
• Factors Affecting Sobriety After Treatment An
  Outcome Study (Unpublished). www.deafhealth.net/c
  d/cd4.htm. Retrieved 8/23/99
• Substance and Alcohol Intervention Services for
  the Deaf (SAISD). Various materials.
  http//rit.edu/sa/coun/saisd.