Interviewing Individuals with Physical Disabilities and Diseases

1. Interviewing Individuals with Physical Disabilities and Diseases Presented by Carri, Katie, Katrin, and Lola

2. Sub-Topics • People with Vision Impairments • People with Terminal Illnesses • People with Drug Addictions • People who are Deaf

3. Interviewing Individuals with Physical Disabilities and Diseases: Vision Impairments

4.  Basic Information on Blindness and Vision Impairments • The definition of "legally blind" is 20/200 with correction • Most people who are considered "blind" have some sight rather than no sight at all. • Visual impairments are ususally considered more of an inconvenience than a disability. • While many people who are blind can read Braille, most do not. • There are an estimated 10 million blind and visually impaired people in the United States, 1.3 million of which are considered legally blind

5.  Common Populations with Vision Impairments Vision impairments can affect people from every culture, age and background. Most commonly you will be interviewing visually impaired people who are: • Elderly • Autistic • Those with a mental condition • Those with a physical disability that affects their vision • Veterans • Blind from birth • Those who are recently blind or visually impaired because of trauma or illness • Those who culturally don’t make eye contact

6.  Importance of Visual Contact in Communication • Over 65% of what is gathered from a conversation is collected by observing non-verbal cues. • Those with visual impairments may be missing out on over 35% of communication cues like: •  facial expressions •  gestures •  head nods • Different techniques must be used to create comfort, show trust  and create clarity.

7. Tips for Approaching an Interview with Individuals with Visual Impairments Here are some things to think about before the interview: • Do you have background detail about your client’s ability? • Are you prepared to offer a longer session of time? • Do you have (or can you get) your confidentiality and general agency forms transcribed? • Be prepared to use physical contact to guide. • Physical contact will last longer. • Can you meet them in their setting? • If in an office setting, be prepared to go out to lobby and meet them.

8.  During the Interview • Ask about their condition and how they are usually accommodated. They know themselves the best. • Mention your nerves or naivety in accommodating visually impaired people. • ALWAYS ASK FOR PERMISSION TO GUIDE! • Guide them to their chair. • Go over forms together. • Never interact with a guide dog when on duty. More tips! à

9.  During the Interview (Continued) • Describe your setting • Describe EVERYTHING you are doing. • Describe it from their point of view. • Don’t describe things by color/size. Descriptions must be relational. • Don’t move things! Keep the set up of the room consistent. More tips! à

10.  During the Interview (Continued) • Check in with the individual every 15 minutes or so. • Direct your voice. Address your speaking directly to them, not away. • Be aware of client’s comfort through unique body cues. • Avoid pausing without speech for too long or moving without      speaking. • Use your voice appropriately. • Describe any things that are affecting your voice. • Always announce when you leave the room.

11. Interviewing Individuals with Physical Disabilities and Diseases: People with Terminal Illnesses

12. Basic information on terminal illnesses • Terminally Ill - signifies a person has a prognosis of 6 or less months to live •  Some common illnesses that are or can become terminal: • Cancers (Pancreatic, Lung, Leukemia...) • Chronic heart & lung conditions • Kidney failures • Alzheimers and other forms of Dementia • Lou Gehrig's disease/ ALS (neuromuscular disease) • AIDS • Services available: • hospital care, hospice care, counseling 

13. When may you need the skills to converse with/interview the terminally ill? • In your personal lives • Via social groups (church, clubs...) • With clients who are nearing death • To relate to clients whose loved ones are dying

14. Knowledge to have before speaking with a terminally ill person • Client's cultural views toward death and dying • Condition of person you are going to interact with

15. Understanding your own death and vulnerability • It is ESSENTIAL that you understand the certainty of your own death • Address any fears you have about death or talking to a dying person. • Ask yourself... • What are you personal values on life and death? • What are your cultural beliefs on death? How could they affect your professional practice? • How would the death of a client of yours affect you?

16. Skills to use when meeting a terminally ill individual • Let the individual know they are attractive and loveable • What are they not saying? Can this be a clue to an issue in their dying process? • Physical Attending: • Get on their level physically • on your knees • on a chair •  Get close • are they hard of hearing? • Show physical care through touch • hold hands, touch shoulder • Focused Listening • Make eye contact

17. Skills for Empathy - Attend to the person, rather than the illness  • Find a way to accept a dying person as a living person, just like yourself, rather than an "other" who is very different and object-like because they are dying (Public Affairs Television, 2000). • Chaplain's tip for empathy - Imagine the dying individual as a young, healthy, child with no wrinkles or scratches • Non-verbal empathy (physical attending) • Let go of your personal distractions • Be sensitive to their pain, but give attention to the PERSON

18. Making a connection through curiousity: Questions to ask a person who is terminally ill  • Are you comfortable talking about your illness/condition? • What does your condition feel like? • What gives you comfort at this time? (respecting integrity of patient; practices beneficence) • Life Review - Questions about their life. Have they already had experiences with death in their life? • Questions about "trivial things" can lead to more substantial conversation

19. Things to avoid when speaking with a terminally ill person • Be careful not to say "you are going to get better." • Avoid using the words "death" or "dying" etc. around the person. Rather, use euphemisms like "passing" or "passed on" (M. Lodge, Personal communication, February 13, 2009). • When meeting only once, do not ask about life regrets and dark experiences - Keep things in the positive realm

20. Interviewing Clients with Addictions More specifically to alcohol and harder drugs

21. Principles of Effective Treatment: • No single treatment is appropriate for all individuals • Treatment needs to be readily available  • Effective treatment needs to attend to multiple needs of the individual, not just his or her drug use • Remaining in treatment for an adequate period of time is critical for recovery- this is usually around 3 months, but depends on the type of drug

23. Treatment Programs include (but are not limited to) : Agonist Maintenance Narcotic Antagonist Outpatient Long or short term Residential Medical Detoxification Prison-based Programs

24. Scientific Theories and Models of Therapy Are meant to supplement and enhance treatment programs. They have all been supported by research through the National Institute on Drug Abuse (NIDA).

25. Motivational Enhancement Therapy The Counselor should: • High level of empathy • Interpersonal warmth  • Ask open-ended questions • Use reflective listening • Roll with resistance  • Support client perception that change is possible & can be accomplished Avoid: • Confrontation/denial trap • Expert role • Closed/short answer questions • Don't label client Basic Principles: • Express empathy • Develop discrepancy • Avoid argumentation • Roll with resistance • Support self-efficacy Phase I: Build motivation for changePhase II: Strengthen commitment to changeFollow-through  Stresses importance of using a significant other (SO) in the process, this works especially well for marijuana addicts & alcoholics.

26. Behavioral Therapy Counselors should: • Focus on current situation & solution • Change views & beliefs about life • Give control to client Counselors should avoid: • Overdependence • Focusing on the past • Changing client personality traits • Teaches behavior modification • Collaborative, action-oriented therapy • Behavioral experiments • Role-play exercises • Skills training • Brief time period therefore relapse is highly possible • Inappropriate for those with cognitive disabilities (depending on level of functioning)

27. Relapse Prevention Counselors should: • Enter into collaborative relationship with client • Supportive & directive approach • Point out self-defeating ways of thinking/acting while advoacting basic integrity of client • Very directive in establishing agenda & maintaining procedures Counselors should avoid: • Projecting problems on clients that they don't have • Avoid harsh confrontation • Cognitive-behavioral • Learning processes play critical role in development of maladaptive behavioral patterns • Learn to identify & correct problematic behaviors • Enhance self-control 5 primary components: • Assessment • Warning sign ID • Warning sign management • Recovery Planning • Relapse intervention training

28.  Tips for Interviewing  People who are Deaf

29. The Definition of Deaf: To be Deaf mean to partially or wholly lacking or deprived of the sense of hearing ; to be unable to hear (2009, Defining Deaf Culture).

30. General tips when Interviewing • Most people who are deaf do not consider themselves to have a disability • Hearing Aids do not completely solve the problem • Be aware of social norms within deaf culture • ASL IS NOT A UNIVERSAL LANGUAGE • I conduct the interview in a well lit area if the client is lip reading • Ask how to client would prefer to communicate during the interview • Speak in a normal tone with a normal seed of speech • Treat everyone with respect General information

31. What to DO during an interview Interviewing without an Interpreter • Interviewing with an Interpreter • obtain a interpreter that specializes in a particular subject if needed. • Position the interpreter next to the interviewer • Eye contact with the client • Speak directly to the deaf or heard of hearing person. • Provide a written copy of the interview question • Use a lot of gestures and facial expressions • Maintain eye contact with client • Be prepared to rephrase questions if necessary

32. What NOT to do during an interview • Do NOT always rely on note taking or just speech reading • DO NOT speak directly to the interpreter • DO NOT assume the client is struggling because they are Deaf • DO NOT assume anything about any client

33. Resources in Whatcom County • Hearing Health Clinic • 2940 Squalicum Parkway, Bellingham WA. • Bellingham Hearing Center Incorporated • 303 Potter Street, Bellingham WA • Hearing Speech and Deafness Center • 114 West Magnolia Street-Suite 316

34. Commonalities • General interviewing skills • respect of the person • empathy • listening • attending • Client has power in how to discuss their illness or disability • Supporting the individual and their needs • Owning your mistakes as interviewer

35. Commonly used Signs

36. Commonly used Signs Cont…

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