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• Deafness• Variables• Communication and Culture• Dysfluency• Deprivation• Implications for Treatment

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DEAFNESS

a) Degree of Deafness

b) Onset of Deafness

c) Presence of Disabilities

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COMMUNICATION

• Deaf population have linguistic diversity:– age of onset/cause of deafness – organic/neurological dysfunction – intellectual ability– language deprivation – age that language acquisition began – educational background – involvement in Deaf community

(Miller & Vernon, 2001)

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SOME IMPORTANT FIGURES(U.K.)

• 1/1000 born with profound bilateral Deafness

• 2.6 /1000 under 10 year olds – deaf (40+dbHL)

• 90% of Deaf children born to hearing parents

• 40% deaf people 25% hearing people experience mental health problems (Ridgeway)

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Pre-verbal Post Verbal

Onset at birth/early age After acquisition of speech/language

Communication based on Sign Language Speech/written word/lipreading

Difficulties - parents and Deaf children Early communication in same language

Impact on emotional/social/psychological/linguistic development

No impact on social, psychological, linguistic, educational development

Identify with Deaf community Often do not identify with Deaf community

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DEAF: IMPACT OF DEPRIVATION

• Linguistic/Social/Emotional/Psychological Lack of language, expressive/receptive skills Concrete/literal understanding Social interactions/understanding Recognition/regulation own and others emotions Minimal language Echopraxia

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COMMUNICATION MYTHS

• Speak loudly/Shout

• Written word – average Literacy 8.5 (Conrad)

• Lipreading

• Nodding syndrome

• Understand Interpreters

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• Parent/Child interaction - hearing parents of deaf children are more directive and discuss less

• Language development: speech v sign

• Implications for social and emotional development

• Major decisions about education

• Complex needs

CHILDHOOD

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• Issues of identity – Deaf/Hearing

• Leaving school – HELP!! Poor Access to FE

• Poor understanding - Social, Moral, Legal, Emotional

• Poor access to training/employment

• Discrimination

• Relationships - How do these work?/Peer Groups

• Mental Health issues

ADOLESCENCE

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• Maturational delays• Gaps in knowledge – Poorly equipped• Access: Health, Education, Employment - limited• Attitudes and discrimination• Additional stressors - MH matters• ‘Low key’ support systems: Family/Friends/primary care services ? Access• Psychosexual Issue

YOUNG ADULTHOOD

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• Dinner Table Syndrome– Family talking: laughing, serious, discussions

• Validating experiences– Lack of communication with siblings/peers

• Lack of access to media/written/TV– Miss opportunity to understand contemporary views

• Misunderstanding information on social media

SOCIAL INTERACTIONS

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• Mainstreaming

• PHU’s- issues of bullying, mixing all ages

• Deaf schools - Residential – Separation/Abuse - Positives – Deaf Community/Role Models

• Further Education/Higher Education problematic

EDUCATION

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• Damaging stigma and discrimination• Impoverished social networks which are associated with

mental health problems• Life in deprived communities which leads to:

• Feeling lonely and life is not worth living• Having lower sense of control over their lives• Problems with rowdy behaviour and harassment

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Deaf people are more likely to experience

• Be excluded from local decision making about services

• Not have fair access to mainstream services and resources

• Not be able to access mainstream services

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Deaf people may

CULTURAL MODEL

• Cultural / linguistic minority

• Use BSL (UK)

• Share social, interpersonal experiences

• Humour, Clubs, Rallies

DEAF PEOPLE

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THE UNIQUENESS OF THE DEAF COMMUNITY

The term “Deaf Community” has demographic, linguistic, political, psychological and sociological dimensions. The Deaf community shares characteristics born from common experiences, beliefs, values and norms. Most importantly the Deaf community bonds through a common language and a shared culture.

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DYSFLUENCY

• A small but significant section of the Deaf community has minimal language skills in verbal and sign language

- co-existing organic, neurological dysfunction- early language deprivation, learning disability

• Pervasive developmental Disorder• Gaps in information, poor awareness of social norms• Deprivation psychological, social, emotional development• Involvement in Deaf Community - Limited

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EEC STUDY – CHILDHOOD DEAFNESS(T MARTIN ET AL)

3000 – Children – 9 countries

• 29% – Disability – Physical/Visual

• 9.9% - Learning Disability

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Dysfluency Compared

DeafHearing

Incoherent MLS Compre- Proficient Fluent Eloquent hensible

Professor Robert Pollard – University of Rochester

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SOME DEAF PEOPLE …

• Learning Disabled/ASC• Deafened• Cochlea Implants• Use spoken and written language• Cannot access Deaf Community without support• Ethnic minorities

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Do not identify themselves as part of the Deaf Community

• Fill in the gaps• Identify the impact of deprivation • MDT assessment and treatment• Develop skill areas/opportunities to practice skills• Target weaknesses

– Compensate for the lack of skills• The team provide Nurturing

HABILITATION

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Shared PathwayM

oral

Val

ues

Recovery&

Relapse

Offence Related• SOTP• Arson• Violence

Anger Trauma Substance

Mental Disorder

Psycho education

Assessment & Risk Assessment

Rehabilitation Model

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• Communication – Emotional vocabulary• Education – Sex Education, Feelings, Interaction• Social Skills – Understanding others needs• Psychological - Coping skills/stress management• Relationships – Therapeutic/Non therapeutic relationship• motivation/encourage appropriate behaviour• New experiences

Pyramid: Targeting an Immediate Priority

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• Age Line• Understanding Emotions Group Programme• Understanding Social Skills Group Programme• Basic Relationship Education Programme• Sexual Education / Relationship Intervention • Substance Misuse• Anger Management

PYRAMID: DEPRIVATION AREAS

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Anger

Emotion Big. You want shout, hit, punch, kick, threaten.

Emotion Posters: Definition

Lowe, Gahir, MacDonald, IAFMHS April 2012

Anger Thermometer: Intensity

Trigger / Start Build up DangerBuild up Angry stay

Anger less Angry / Upset

Anger Small/ Upset Big

UpsetCalmer Calm

big

THINK

GO

STOPDON’T DO IT. DON’T HIT OUT OR REACT

WHATS WRONG?WHAT CAN I DO? WHAT ARE THE OR COSTS?

MAKE A PLAN & TRY IT THINK POSITIVE BE CALM

ANGER MANAGEMENT

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Habilitation Treatment Approaches

H O P E

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HEARING CARE PATHWAY

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“What matters deafness of the ear when the mind hears? The true

deafness, the incurable deafness, is deafness of the mind.”

Victor Hugo, 1845

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Any Questions? ? ?

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