Deaf and Hard of Hearing Children Hearing Children of Deaf Parents

Considerations in Enhancing Capacity to Provide Effective Trauma Treatment for Culturally Isolated Populations Deaf and Hard of Hearing Children Hearing Children of Deaf Parents

Subgroup for Deaf & Hard of Hearing Family Trauma Treatment Program Mental Health Corporation of Denver • Ric Durity -- Mary Sterritt • Ami Garry -- Karen Mallah Child Trauma Treatment Network - Intermountain West Primary Children’s Medical Center of Salt Lake • Amy Oxman Utah Community Center for the Deaf and Hard of Hearing • Annette Stewart -- Joene Nicoliasen

Subgroup for Deaf & Hard of Hearing (cont’d.) Exceptional Children’s Program - Scotland County Schools (NC) • Gary Mauk

Background Information • Deaf children are at greater risk for maltreatment (Sullivan, Brookhouser, Scanlan, 2000) • 50% of deaf girls have been sexually abused • 54% of deaf boys have been sexually abused • 28 million Americans have a hearing loss (83.3 per 1,000) • 2 million Americans are profoundly deaf (7.5 per 1,000)

Addressing Disparity in Accessing Care for Culturally Isolated Populations • Too few “specialized” providers with fluency in sign language and expertise in cultural, communication, and psychosocial needs of Deaf & HoH children • Consultative model enhances capacity of “mainstream” providers to provide treatment • Bulletin identifies those factors that “mainstream” providers must consider in providing assessment and treatment

‘Deaf’initions of Deafness Disability or Difference? • The medical/pathological view: • Hearing parents, educators, clinicians, & payers often see deafness as defect or handicap • Distinguish “abnormal” deaf from “normal” hearing • This view is important in preserving legal rights under the Americans with Disabilities Act • Treatment emphasis is on “curing” the effects of Deafness

‘Deaf’initions of Deafness (cont’d) Disability or Difference? • The cultural view: • Deaf community sees deafness as merely “a difference” • A community with a unique positive culture, a beautiful language, unique forms of artistic expression, and a rich history • Treatment emphasis involves affirming and supporting positive self regard

“Deaf”initions of Culture • “The system of shared beliefs, values, customs, behaviors, and artifacts that the members of society use to cope with their world and with one another, and that are transmitted from generation to generation through learning.” • A group of persons who share a common language, social affiliation, educational background, and a shared experience of oppression.

Culturally Isolated Youth • Deaf, hard of hearing, & hearing children of deaf adults (CODA’s) • Interracial adoptees • International adoptees • Biracial children • Children of immigrants • Youth in upwardly mobile families of color • Lesbian, gay, bisexual, & transgendered youth

Vignette “James” is a 12 y.o. deaf boy, who recently disclosed recurrent sexual abuse by a signing soccer coach. He disclosed to his 8 y.o. brother, after the brother described to him (in ASL) the content of a sexual abuse prevention curriculum being taught in his 3rd grade class. Reportedly, “James” stated that his parents were very angry at him when they found out and now he is not allowed to play with friends or go anywhere after school. “James” has recently been fighting in school, and has had difficulty sleeping. His parents and his teacher have referred him to your program.

Treatment Considerations • History of language use and hearing loss • Educational background • Social emotional development • Culturally relevant supports • Increased risk of trauma • Using an interpreter • Model adaptation

History of Language Use and Hearing/Deafness Status • Gather history re: hearing/deafness status • What language: • do you prefer to use? • do you use with your friends? • do you use with your family? • do you use most in school? • would you like to use in therapy? • How well can your parents communicate with you?

Educational background • What type of school setting are you in now? • Have you ever attended a different school? • Where did you learn the most/like it best? • Why was that setting your favorite? • What has been the most difficult thing for you in school? • What do you do best/like most at school?

Social-Emotional Developmental • experience social isolation within the family context • restricted opportunities for incidental learning • possible deficits in social understanding • misattribution of the causes & effects of their own and others’ behaviors • tend to show greater impulsivity and poorer emotional regulation • have an impoverished vocabulary of emotion language • difficulty fitting in with hearing peers (M.Greenberg, 2000)

Culturally Relevant Supports • Does the child have a Deaf role model/ mentor in the community? • What positive activities does the child participate in? • What language is spoken there? • Does the child feel accepted there? • At what level does child participate in important family activities such as social and religious gatherings?

Increased Risk of Trauma • Due to: • increased frustration by adults and children due to communication barriers • difficulty teaching Deaf children about safety due to communication barriers • paucity of adapted safety curricula and sexual abuse/kidnapping prevention programs • Deaf children may be seen by perpetrators as less able to disclose

Increased Risk of Trauma • Due to: • less skill building and socialization in the home and at school • less opportunity for incidental learning • fewer trusting, open relationships for the child • less disclosure of abuse to caregivers • less understanding of the parameters of healthy/ safe touching

Using an Interpreter • Role of interpreter is to facilitate communication in the preferred language modality of the deaf person • Assurance that the interpreter is qualified • Client confidentiality and the interpreting Code of Ethics • Legal obligation to provide an interpreter if requested

Working Effectively with an Interpreter • Hold pre- and post- sessions with interpreter • Arrange physical placement to maximize your direct eye contact with client • Look and speak directly to the deaf individual not the interpreter • Interpreter has ethical obligation to interpret all that is said in the room • Work with the interpreter to repeat or rephrase as necessary to ensure the client is understanding • Be aware of transference/counter transference issues involving the interpreter

Adaptation of Trauma Focused-CBT • Individual child sessions • modify relaxation techniques as necessary • trauma narrative may need to be done with a more visual medium than writing • therapist (with interpreter) may need to teach the child appropriate words for what has happened to them • may need to work longer and with more detail on socialization and safety

Adaptation of Trauma Focused-CBT • Parent training • emphasize consistent rules and consequences • decrease guilt • decrease over-protectiveness, while helping to increase knowledge of self-protection • help facilitate use of signing/Deaf supports • may need to spend significant time on the historic lack of communication and culture gap

Adaptation of Trauma Focused-CBT • Joint parent/child sessions • ensure that everyone in the family can follow the communication and can fully participate • ensure that the child is using his/her preferred language even if parents prefer another

To a Hearing MotherBy Ella Mae Lentz (Based on a translation from the ASL by the author.) You and I are different. Different worlds, languages, life experiences. You grew up ignorant of Deaf people though You may have heard of a few Here and there. I grew up in the DEAF-WORLD, all too familiar with the hearing and their oppressive ways.

To a Hearing Mother (cont’d.) Now you give birth to a boy. He’s Deaf! You’re shocked! I’m surprised and delighted! You struggle to make the boy like you. However, he’ll grow up to be like me. He has your likeness. However, he has my ears, soul, language and world view. He’s your son, but he’s of my people. Then, who does the boy belong to? You or me? He’s like a tree.

To a Hearing Mother (cont’d.) Without our people, he would wither and be left with no soul, no sense of self. But without you, there wouldn’t be any trees. Our great people and language would dwindle. Our struggles and fighting can be like a saw that brings down the tree. We must stop it, and share, and love, and accept and together be the ground to nourish the tree So it will grow tall, proud and strong. And seek the heavens.

References • Critchfield, A. B. (2002). Cultural diversity series: Meeting the mental health needs of persons who are Deaf. Alexandria, VA: National Association of State Mental Health Directors (NASMHPD) • Glickman, N.S., & Gulati, S.(eds.) (2003). Mental Health Care of Deaf People: A Culturally Affirmative Approach. Mahweh, NJ: Lawrence Erlbaum. • Greenberg, M.T., & Kusche, C. (1989). Cognitive, personal and social development of deaf children and adolescents. In M.C. Wang, M.C. Reynolds, & H.J. Wahlberg (eds.) Handbook of Special Education: Research and Practice (vols. 1-3). Oxford: Pergamon Press. 95-129.

References • Hindley, P., & Kitson, N.(eds.) (2000). Mental Health and Deafness. London: Whurr Publishers. • Registry of Interpreters for the Deaf (2000). Standard Practice paper: Interpreting in mental health settings. Alexandria, VA: Registry of Interpreters for the Deaf • Sullivan, P.M., Scanlan, J.M., Brookhouser, P.E., & Schulte, L.E., (1992). The effects of psychotherapy on behavior problems of sexually abused deaf children. Child Abuse & Neglect, 16, 297-307. • Wixtrom, C. (1988,Winter) Two views of deafness. The Deaf American.

Deaf and Hard of Hearing Children Hearing Children of Deaf Parents