Models of deafness

Objectives: Discriminate medical and social models

of deafness. Recognize related biases in self and

others.

Deaf history

Deaf history 1500-1600s Beginning of formal deaf education

1880 Milan Congress on Deaf Education Oral education preferred to sign education Homogenized deaf people

1964 Babbidge Report Oral education method is failing deaf students

1988 Deaf President Now Board of Gallaudet University appointed a hearing

person as its 7th president Students protest until president resigns

1990 IDEA passes Deaf schools considered “Most Restrictive Environment”

Technological Revolution

TTYs

Closed Captioning

Mobile Text

Instant Messaging/ Skype

Video Relay Service

Assistive Devices

Hearing Aids

OAE/ABR

Newborn Hearing Screening

Cochlear Implants

Medical model

Deafness as pathology

Deafness as treatable

Deafness as curable

Sociocultural model

Deafness as identity

Deafness as special

Deafness as linguistic / cultural minority

World Health Organization International

Classification of Functioning (ICF)

Functioning is an outcome of interactions between health conditions and contextual factors

Health conditions

Disease, disorders, injuries

Contextual factors

External: environment, social structures, terrain, etc.

Internal: personality, age, SES, education, etc.

Functioning and Deafness

Health Conditions

Medical

Contextual Factors

Social

Deaf Epistemology

Audism

Body is starting point for social classification

Deaf bodies are broken

Muteness = less intelligent

Education and occupational systems not structured to accommodate hearing loss

Visually-oriented

Hauser 2010

Silent news cartoon (~1994)

Press release 4/27/09

Cochlear Americas Launches New Rehabilitation Program for Cochlear Implant Recipients About Cochlear Americas

Cochlear Americas is the world's leader in advanced hearing technologies. Since launching the first multichannel cochlear implant system more than 25 years ago, Cochlear Limited and its U.S. headquarters have brought the miracle of sound to more than 150,000 hearing-impaired individuals across the globe. Cochlear Americas‟ state-of-the-art cochlear implant technology, based on extensive research and development at preeminent academic institutions, provides the ability to hear sound and better understand speech, enhancing both learning capabilities and quality of life for those with severe-to-profound hearing loss.

How does Communication Disorders and Sciences fit into this discussion?

Counseling

Objectives: Contrast informational and adjustment

counseling. Identify response types useful in

counseling.

Informational counseling

Also called content counseling

Description of hearing loss

Explanation of intervention choices

Typically doesn‟t address emotional affect of hearing loss

Typically one-way, practitioner to client

Adjustment counseling

Provide a comfortable climate where positive and negative feelings can be expressed without penalty

Encourage client to verbalize how he/she feels others perceive him/her

Explore nature of interpersonal relations and how having a hearing loss affects them

Help client discuss, analyze and evaluate feelings

Sanders 1982

Adjustment counseling

Facilitate definition of situations/ events that arouse those feelings

Help client explore various ways of dealing with feelings and evaluate effectiveness of those ways

Encourage client to express feelings about self, the handicap, frustrations and aspirations

Sanders 1982

Closed versus open questions

Closed questions

Can be answered with a single word.

Stifle expression.

Can seem directive.

Open questions

Can be answered broadly.

Encourage expression.

Lead to further awareness.

Closed versus open questions

1. Are you sad?

2. How are you feeling?

3. When do you have that experience?

4. Do you like your teacher?

5. What are the advantages of doing it that way?

6. Does your mother agree?

7. Are you going to stop talking to that boy who‟s been teasing you?

Parent concerns

My child is deaf. She’ll never hear anything. Focuses on negative, what‟s missing. Switch

focus to positive, what‟s available.

Will the hearing aid/cochlear implant correct/cure the hearing problem? Derives from hope that child can become

“normal”. The intervention can enhance hearing, but,

unlike glasses, will not allow her to hear as though there were no impairment.

Will my child learn to talk? Will my child be able to go to school?

Sanders 1982

Responding to parents

What they say vs. what they mean.

“I know you‟ll be mad, but Ashley hasn‟t been wearing her hearing aids the past 2 weeks”

How do you respond?

Types of responses

Honest

Hostile

Judging

Reassuring

Reflective

Silent

Nonverbal

Clark & English 2004

Honest response

Give full answers with no “silver linings”

Give realistic answers

Do not prognosticate with insufficient supporting data

Hostile response

Typically a response to a perceived affront of the professional‟s knowledge or training

Never become hostile with a hostile patient

Show that you respect and understand their frustration

Judging response

Passing judgment on patient‟s actions

Projecting onto patient‟s how we believe they should act

Should allow patients to talk out their feelings and attitudes

Reassuring response

Can stifle patient‟s ability to express how they are feeling.

How would you feel if someone told you, “It‟s not as bad as it seems” or “Lots of people have it worse than you”

Reflective response

Reflection is the attempt to understand the patient‟s viewpoint and communicate that understanding in a way that permits the patient to examine their feelings from another perspective.

Develop an understanding through reflection of the patient‟s feelings.

“You don’t feel your child is hearing significantly better in many environments?”

“You are angry that your teacher doesn’t see how hard you are trying?”

Silent response

Silence can provide temporal space for reflection and an opportunity for patients to assume responsibility for their own progress.

Gives patients permission to take time for struggling with emotions.

Nonverbal response

Includes tone of voice, posture, eye contact, gesture.

Good nonverbal responses include

Eye-level communication

Good eye contact

Leaning forward

Purposeful head-nodding

Child concerns

Kids won’t play with me because I don’t hear everything they say

I’m afraid to tell other kids I wear hearing aids

I’m afraid to talk in class in case I didn’t understand

I’m afraid to talk to the cute boy who my friend says likes me

Child concerns

I’m afraid to try out for an activity because my hearing/speech isn’t good enough

I’ve stopped wearing my hearing aid because I’m embarrassed

The teacher won’t call on me because my speech embarrasses everyone

Child concerns

Hearing loss will

jeopardize relationships with peers

limit developing relationships with potential dating partners

affect acceptance by teachers

limit academic achievement

Do not minimize the concerns!

Accept the child‟s statement

It‟s true for them

Explore the feelings

Consider situation where feeling arises

Investigate ways of dealing

If you did X, what‟s the worst thing that could happen?

Counseling checklist

Help children tell their story

Help them clarify their problem

Help them challenge themselves to solve the problem

Help them set a goal

Help them develop an „action plan‟

Observe as they implement the plan

Help them evaluate the plan

From English, K. (2002) Counseling Children with Hearing Impairment and Their Families.

It is better to say

“What do you think is the best thing for you to do next?”

than

“What you should do next is…”

I Start, You Finish

Open-ended activity to understand child‟s self-awareness and self-perception

Do not sit face-to-face, but side-by-side or at right angles “I have some sentences here that have no

endings. I was wondering how you wouldcomplete them. I‟ll start them off and askyou to finish them for me. You can add moresentences to each one if you want. We cantake our time and talk about your sentencesfor as long as you want.”

I Start, You Finish

I am happy when…

I am sad when…

The thing I like most in the world is…

The thing I would most like to change is…

Because I have a hearing problem…

I‟m afraid to…

I wish…

One thing I do very well is…

One thing I like about myself is…

I Start, You Finish

“Thank you for teaching us what it‟s like for you. Is there any help you need from me?”

Open-ended

Child can explore anything he/she chooses

If child seems uncomfortable, end the activity.

Dreams and Maps

Encourage child‟s responsibility and ownership of hearing loss by developing goals.

Each goal and each child involves unique steps, they need to be considered and discussed one at a time.

Child may see how use of communication strategies and amplification fit into goals.

Dreams and Maps

Dreams and Maps

Play tetherball

with other kids

at recess

Dreams and Maps

May need to reassess steps to goal to see if they are working.

Can use SMART goal technique to help child formulate their plan.

When to refer

If the situation is beyond your scope of practice

marital, familial, financial stress

emotional fragility

If you don‟t feel comfortable

Have referral information readily available