Robert Q. Pollard

Mental health of deaf people

Deafness is a heterogeneous condition with far-reaching effects on social, emotional, and cognitive development. Onset before language has been established happens in about seven per 10,000 people. Increased rates of mental health problems are reported in deaf people. Many regard themselves as members of a cultural minority who use sign language. In this Review, we describe discrepancies between a high burden of common mental health disorders and barriers to health care. About a quarter of deaf individuals have additional disabilities and a high probability of complex mental health needs. Research into factors affecting mental health of deaf children shows that early access to effective communication with family members and peers is desirable. Improved access to health and mental health care can be achieved by provision of specialist services with professionals trained to directly communicate with deaf people and with sign-language interpreters.

Health-Related Vocabulary Knowledge Among Deaf Adults

BACKGROUND Many deaf individuals are at increased risk for fund-of-information deficits, including deficits in health-related information. Research on health information knowledge, an aspect of health literacy, demonstrates an association between low health literacy and health disparities in many populations. Deaf individuals are at particular risk for low health literacy, but no research has been conducted on this topic. OBJECTIVE To investigate health-related vocabulary knowledge in a sample of deaf adults. MEASURE A task based on the Rapid Estimate of Adult Literacy in Medicine (REALM). PARTICIPANTS Fifty-seven deaf adults reported whether they did or did not comprehend 66 health-related terms from the REALM. Of the participants, 81% possessed a college degree. RESULTS Thirty-two percent of the deaf participants earned scores on the modified REALM task comparable to REALM scores considered indicative of low health literacy. The pattern of words that were least commonly and most commonly understood differed from normative expectations of hearing REALM respondents. CONCLUSIONS This highly educated deaf participant sample demonstrated risk for low health literacy. The general deaf population is likely at even higher risk for health problems associated with low health literacy.

Community Participatory Research With Deaf Sign Language Users to Identify Health Inequities

Deaf people who use American Sign Language (ASL) are medically underserved and often excluded from health research and surveillance. We used a community participatory approach to develop and administer an ASL-accessible health survey. We identified deaf community strengths (e.g., a low prevalence of current smokers) and 3 glaring health inequities: obesity, partner violence, and suicide. This collaborative work represents the first time a deaf community has used its own data to identify health priorities.

Context-based Ethical Reasoning in Interpreting: A Demand Control Schema Perspective

Abstract Ethical interpreting practice must be predicated on an ongoing analysis of relevant contextual factors that arise in the interpreting situation. Although endorsed to some degree in interpreting pedagogy, this assertion runs counter to much of the history and continuing rhetoric of the interpreting field. Interpreting students receive a mixed message when educators assert a non-contextual, rule-based approach to ethics while simultaneously responding to both ethical and translation questions with “It depends” – an obvious reference to the centrality of context in decision making. This article elucidates a teleological (outcomes-focused) ethical reasoning framework which hinges on a continuing analysis of the dynamic context of the interpreting situation. Grounded in the construct of practice profession responsibility, this approach scrutinizes the co-created dialogue between the interpreter, the consumers who are present, and the context of their collective encounter. It is argued here that critical reasoning in the service of work effectiveness equates to ethical reasoning, even if an ethical dilemma per se has not arisen. The authors’ approach to context-based interpreting work analysis and decision making, the demand control schema (DC-S), has been the subject of several research studies, including a recently-concluded dissemination project involving 15 interpreter education programmes across the United States.

A Community-Participatory Approach to Adapting Survey Items for Deaf Individuals and American Sign Language

Deaf individuals are underrepresented in survey research. Participation is impeded by telephone access, literacy, language, and sociocultural factors in the Deaf community. Knowledge regarding deaf population health disparities is limited by participation barriers in health surveillance surveys. A linguistically and culturally accessible survey of health and health risks was recently developed for deaf individuals who use American Sign Language (ASL), through adherence to the principles and practices of community-based participatory research (CBPR). During that effort, Deaf community representatives and hearing researchers formed a Translation Work Group (TWG) that adapted English health survey source material into ASL. Film clips of the translated items and answer choices were incorporated into a touch screen computer interface. The organization, philosophies, and procedures of the TWG are detailed, as are translation challenges the authors faced and lessons learned. The experiences of the TWG may inform other researchers engaged in cross-cultural, cross-linguistic translation work.

Integrating primary care and behavioral health with four special populations: Children with special needs, people with serious mental illness, refugees, and deaf people.

Special patient populations can present unique opportunities and challenges to integrating primary care and behavioral health services. This article focuses on four special populations: children with special needs, persons with severe and persistent mental illness, refugees, and deaf people who communicate via sign language. The current state of primary care and behavioral health collaboration regarding each of these four populations is examined via Doherty, McDaniel, and Bairds (1996) five-level collaboration model. The section on children with special needs offers contrasting case studies that highlight the consequences of effective versus ineffective service integration. The challenges and potential benefits of service integration for the severely mentally ill are examined via description of PRICARe (Promoting Resources for Integrated Care and Recovery), a model program in Colorado. The discussion regarding a refugee population focuses on service integration needs and emerging collaborative models as well as ways in which refugee mental health research can be improved. The section on deaf individuals examines how sign language users are typically marginalized in health care settings and offers suggestions for improving the health care experiences and outcomes of deaf persons. A well-integrated model program for deaf persons in Austria is described. All four of these special populations will benefit from further integration of primary care and mental health services.

Intimate Partner Violence Reported by Two Samples of Deaf Adults via a Computerized American Sign Language Survey

A computerized sign language survey was administered to two large samples of deaf adults. Six questions regarding intimate partner violence (IPV) were included, querying lifetime and past-year experiences of emotional abuse, physical abuse, and forced sex. Comparison data were available from a telephone survey of local households. Deaf respondents reported high rates of emotional abuse and much higher rates of forced sex than general population respondents. Physical abuse rates were comparable between groups. More men than women in both deaf samples reported past-year physical and sexual abuse. Past-year IPV was associated with higher utilization of hospital emergency services. Implications for IPV research, education, and intervention in the Deaf community are discussed.

Deaf Victims’ Experiences With Intimate Partner Violence The Need for Integration and Innovation

While in recent years, intimate partner violence (IPV) has attracted considerable research attention, the experiences of IPV affecting the Deaf community have been understudied. As a linguistic and cultural minority, Deaf victims of IPV encounter significant barriers in accessing information and services designed to address the medical and legal consequences of victimization. The number of Deaf Americans who communicate via American Sign Language (ASL) may well exceed a half-million, yet little is known about Deaf IPV victims’ experiences and the characteristics of persons who perpetrate IPV with ASL users. This study addressed both topics. The current study is based on interviews in ASL with 14 Deaf IPV victims (participants). We explored: the types of abuse participants experienced; characteristics of victims and perpetrators; participants’ help-seeking behaviors; and the availability, use, and helpfulness of various resources. These findings were compared to what is known about IPV in the hearing community. Our findings include that lack of information regarding IPV and lack of access to specialized IPV services were pervasive problems affecting Deaf victims. For some victims, the close-knit nature of the Deaf community was a barrier for discussing IPV and accessing information and support. It was common for Deaf victims to receive services or information about IPV from providers who were not IPV specialists. Communication abuse was prevalent in our study. The nature of communication abuse is unique for Deaf victims compared to hearing victims.

Capitalizing on Community Resources to Build Specialized Behavioral Health Services Together with Persons who are Deaf, Deafblind or Hard of Hearing.

There are relatively few counselors, psychologists, psychiatrists, and social workers who specialize in serving people who are Deaf, Deafblind or hard of hearing in the United States. Professionals that serve minority populations are often an insular group. They tend to network most often with fellow professionals who understand the language and cultural needs of their service population. Such specialized behavioral health providers rarely have the opportunity to interface with “mainstream” program planners, funders and administrators. Consequently, new recovery agendas, best practice models and community reintegration ideas are only slowly integrated into the care of persons who are Deaf, Deafblind or hard of hearing. We describe the development and implementation of a task force comprised of “front line” providers, administrators, county government officials, advocates and consumers that has made strides toward effective change in a local behavioral health care system. Methods employed, successes, barriers and other reflections on the task force’s efforts also are described.