Deafness and Mental Health Services: Barriers and Facilitators: New York’s Capital District Region

1. Deafness and Mental Health Services: Barriers and Facilitators:New York’s Capital District Region Hee Chul Kim, MSW Heather Horton, PhD State University of New York at Albany SSWR January 15, 2011

2. Background Though the Deaf community is enjoying the benefits of being recognized as a unique cultural group with its own language and shared history, most mental health service delivery systems remain culturally insensitive and inadequately prepared to serve the population.

3. Communication Issues in Mental Health Services • Setting up appointments, • Understanding medications, and • Exchanging information generally Specific Issues • Interpreters in mental health settings • Clinicians using ASL • Deaf Community and Deaf Culture • Terminologies, language

4. Method • Participants • Stakeholders in New York’s Capital Region • n=9, 5 deaf; 4 hearing • 2 certified interpreters • Procedure • Videotaped Focus group held at the University at Albany School of Social Welfare (2hrs) on May 19, 2009. • Consensus made among participants on communication method (ASL only) • Analysis • Transcribed by certified interpreter • Text was coded into themes • Inter-rater reliability was garnered by a comparison between the first and second author’s recoding of the data. • Analysis of data was supported by Atlas-ti.

5. Results Barriers to Effective Mental Health Services for the Deaf • Most Typical Barriers (common nationally): • Medicaid not accepted • Lack of Qualified Mental Health Sign Language Interpreters • Geographically widespread deaf population

6. Barriers in New York’s Capital Region • County-based services • Only severely mentally ill clients can be referred to another county • State-Based Services • Inability to refer consumers to another state that may provide higher quality, or more comprehensive services. • Example: Out-of-state referral system in other parts of country • General lack of funding & current economic climate.

7. Facilitators to Effective Mental Health Services for the deaf • Culturally competent therapist • Technology • Culturally sensitive interventions content analysis cont.

8. Deaf female participant • “[I]t may be better to have a hearing therapist who can sign so my children can speak with them…[in this case] the therapist can communicate directly with me as well. If this were to be done with an interpreter there is too much room for error. This would be too important to make any mistakes.”

9. Action Suggestions for effective mental health services for the Deaf • Lobbying, gaining political support • Research leading to Grant Writing • How should we begin? • Task force development

10. Discussion & Recommendations • Service-level factors • Culturally Sensitive Professionals • Physical Environment • System-level factors • Inter-County and Inter-State Collaborative Mental Health Service Delivery System • Insurance • Research • Basic research • Intervention research (e.g., SCIT)

11. Recent Research • Horton, HK and Silverstein SM (under review). Visual context processing deficits in schizophrenia: effects of deafness and disorganization. • Horton HK and Silverstein SM (in press). Factor structure of the BPRS in deaf people with schizophrenia: correlates to language and thought. Cognitive Neuropsychology. • Horton HK (2010). Linguistic ability and mental health outcomes among deaf people with schizophrenia. Journal of Nervous and Mental Disease 198 (9), 634–642. • Horton HK and Silverstein SM (2008). Social cognition as a mediator of cognition and outcome among deaf and hearing people with schizophrenia. Schizophrenia Research 105 (1-3), 125–137. • Horton HK and Silverstein SM (2007). Cognition and functional outcome among deaf and hearing people with schizophrenia. Schizophrenia Research 94 (1-3), 187– 196.

12. THANKYOU