Modifying Dialectical Behavior Therapy for Deaf Individuals

Developing Signs of Safety: A Deaf-accessible counselling toolkit for trauma and addiction

The U.S. Deaf community-more than half a million Americans who communicate using American Sign Language (ASL)-experiences higher rates of trauma exposure and substance use disorder (SUD) than the general population. Yet there are no evidence-based treatments for any behavioural health condition that have been evaluated for use with Deaf people. The driving aim of our work, therefore, has been to develop and formally evaluate a Deaf-accessible trauma/SUD counselling approach. Here we describe our initial intervention development work and a single-arm pilot that evaluated the feasibility, acceptability, and preliminary clinical efficacy of Signs of Safety-a Deaf-accessible toolkit to be used with an existing, widely adopted protocol for trauma and addiction (Seeking Safety). Preliminary efficacy results indicated clinically significant reductions in PTSD symptoms and frequency of alcohol use for the Seeking Safety/Signs of Safety model. Frequency of drug use did not change significantly-likely attributable to the mid-study legalization of recreational marijuana in our state. Next steps include the redesign and refilming of Signs of Safety based on pilot participant feedback, again using a Deaf-engaged development and production process. This new toolkit will be tested via a pilot randomized controlled trial designed based on present methodological lessons learned.

„Mixed-methods“-Studie zu Barrieren in der ambulanten Psychotherapie von Gehörlosen

Hintergrund

Trotz einer erhöhten Prävalenz von komorbiden Beeinträchtigungen und psychischen Erkrankungen gibt es für Gehörlose Barrieren in der psychotherapeutischen Behandlung.

Ziel der Studie

Diese Arbeit untersucht, wie ambulant arbeitende Therapeut*innen mit Anfragen von Gehörlosen umgehen, und welche Rahmenbedingungen für eine gelingende Behandlung benötigt werden.

Material und Methoden

Nichtärztliche niedergelassene Psychotherapeut*innen eines Stadtkreises wurden zur Teilnahme an Studie 1 eingeladen. Es beantworteten 71 von 209 angeschriebenen Psychotherapeut*innen einen Fragebogen, mit dem quantitative und qualitative Daten zum Umgang mit Therapieanfragen und zu den Rahmenbedingungen für die Behandlung erhoben wurden. In Studie 2 nahmen 8 dieser Teilnehmer*innen an einem leitfadengestützten Interview teil, in dem die Befunde aus Studie 1 zu den Voraussetzungen für eine gelingende Behandlung Gehörloser vertieft wurden.

Ergebnisse

Viele Therapeut*innen berichteten von fehlenden Erfahrungen mit Gehörlosen (n = 60; p = 84,5 %) und fehlenden Therapieanfragen von Gehörlosen (n = 69; p = 97,2 %). Zukünftige Anfragen von Gehörlosen würden 64,8 % der Therapeut*innen (n = 46) ablehnen. Diese Entscheidung hängt mit der bisherigen Erfahrung mit Gehörlosen zusammen, χ2 (1) = 6,378; p = 0,012. In Studie 2 wurden Barrieren bei der Kontaktaufnahme, der Diagnostik und der Behandlung aufgrund von Kommunikationsschwierigkeiten identifiziert.

Schlussfolgerung

Therapieanfragen von Gehörlosen werden aufgrund mangelnder Therapiekenntnisse und erwarteter Kommunikationsschwierigkeiten abgelehnt. Mithilfe einer gelingenden Kommunikation, von Fortbildungsmöglichkeiten und der Aufnahme des Themenbereichs Gehörlosigkeit ins Direktstudium Psychotherapie können diese Barrieren verringert werden.

Creating the Capacity to Screen Deaf Women for Perinatal Depression: A Pilot Study

OBJECTIVE

Compared to hearing women, Deaf female sign language users receive sub-optimal maternal health care and report more dissatisfaction with their prenatal care experiences. As healthcare providers begin to regularly screen for perinatal depression, validated screening tools are not accessible to Deaf women due to severe disparities in English literacy and health literacy.

DESIGN AND SETTING

We conducted a one-year, community-engaged pilot study to create an initial American Sign Language (ASL) translation of the Edinburgh Postnatal Depression Scale (EPDS); conduct videophone screening interviews with Deaf perinatal women from across the United States; and perform preliminary statistical analyses of the resulting pilot data.

PARTICIPANTS

We enrolled 36 Deaf perinatal women between 5 weeks gestation up to one year postpartum.

MEASUREMENTS AND FINDINGS

Results supported the internal consistency of the full ASL EPDS, but did not provide evidence of internal consistency for the anxiety or depression subscales when presented in our ASL format. Participants reported a mean total score of 5.6 out of 30 points on the ASL EPDS (SD = 4.2). Thirty-one percent of participants reported scores in the mild depression range, six percent in the moderate range, and none in the severe range.

KEY CONCLUSIONS AND IMPLICATIONS

Limitations included small sample size, a restricted range of depression scores, non-normality of our distribution, and lack of a fully-standardized ASL EPDS administration due to our interview approach. Informed by study strengths, limitations, and lessons learned, future efforts will include a larger, more robust psychometric study to inform the development of a Computer-Assisted Self-Interviewing version of the ASL EPDS with automated scoring functions that hearing, non-signing medical providers can use to screen Deaf women for perinatal depression.

Depression in Deaf and Hard of Hearing Youth

Depression has been shown to be more prevalent in deaf and hard of hearing (DHH) youth than in their hearing peers. This increase in vulnerability likely stems from communicative barriers in a hearing world and adverse experiences related to stigma and discrimination. There are a variety of factors to consider in the assessment and treatment of depression in DHH youth. Additional attention, research, and resources are needed to support children and their families early on in life to reduce the impact associated with deafness, and to improve prevention and treatment of depression in this vulnerable population.

Exploration des besoins de services des personnes sourdes locutrices LSQ présentant des troubles de santé mentale

Introduction Malgré les constats des milieux de pratique qu’il existe un problème d’accessibilité aux services en santé mentale pour la population sourde locutrice de la LSQ, très peu d’études québécoises se sont intéressées aux besoins de services en santé mentale pour ces personnes.

Objectif Cette étude visait à explorer les besoins de services des personnes sourdes locutrices de la LSQ présentant des problèmes de santé mentale.

Méthodes Une étude de cas unique qualitative avec pour cas la région desservie par un centre de réadaptation spécialisé en surdité et communication fut réalisée. L’échantillon était composé d’intervenants et de gestionnaires de ce centre et d’organismes communautaires (n = 12) de personnes sourdes locutrices de la LSQ présentant des problèmes de santé mentale (n = 4) et de proches (n = 1). Chaque acteur-clé a participé à une entrevue individuelle suivie d’un entretien de validation. Une analyse de contenu thématique fut effectuée selon la méthode de Miles et Huberman (2003).

Résultats Certains services souhaités étaient inexistants pour les personnes sourdes avec des troubles de santé mentale, tels que des réseaux d’entraide et des activités de loisirs. Certains services étaient disponibles, mais plusieurs obstacles affectaient leur utilisation, dont la méconnaissance de la surdité et de la culture sourde dans le réseau qui engendre diverses conséquences comme des diagnostics erronés.

Conclusion Ce qui semble faire consensus pour ces participants est l’importance d’avoir des cliniciens dans les divers établissements avec une très bonne connaissance de la santé mentale, de la surdité et des aspects linguistiques et culturels caractérisant la clientèle sourde.

A dialectical behavior therapy skills intervention for women with suicidal behaviors in rural Nepal: A single-case experimental design series

BACKGROUND

Suicide in low- and middle-income countries (LMICs) accounts for 75% of the world's burden of suicide mortality and is the leading single cause of death among Nepali reproductive age women. To advance treatment for suicidal behaviors in LMICs, a single-case experimental design (SCED) was conducted of a culturally adapted Dialectical Behavior Therapy skills intervention for Nepali populations (DBT-N).

METHOD

Ten Nepali women with histories of suicidality participated in the 10-session intervention. Outcomes of emotion regulation, suicidal ideation, depression, anxiety, resilience, and coping skills use were measured at multiple time points pre-intervention, during, and at follow-up. Qualitative interviewing assessed DBT-N's feasibility and acceptability.

RESULTS

Participants showed improvements in emotion regulation over the course of treatment, which were associated with increased skills use. Rapid, sustained reductions in suicidal ideation and improvements in resilience were observed after DBT-N initiation.

CONCLUSION

This SCED supports conducting further evaluation of DBT-N through controlled trials with emotion regulation as a target mechanism of action for reducing suicidal behaviors in LMICs.

A pilot program in rural telepsychiatry for deaf and hard of hearing populations

Background

Access to mental health care in deaf communities is limited by cultural considerations, availability of translators, and technological considerations. Telepsychiatry can mitigate the deaf community’s lack of access to care by allowing for deaf individuals in remote communities access to care with facilities that cater to their needs.

Methods

Community Behavioral Health, Arundel Lodge, and Gallaudet University worked in conjunction to test three hypotheses:

1.

Telepsychiatry will be as effective as traditional face-to-face psychotherapy with deaf adults who have chronic mental illness.

2.

Patients living in remote locations will report an improvement in accessibility to mental health services.

3.

Patients who receive telepsychiatry will report a comparable level of satisfaction of services to those receiving traditional services.

The patient sample consisted of 24 participants, 13 women, 11 men. Telepsychiatry sessions were scheduled based on each patient’s individual treatment plan against a control group who saw their providers face to face.

Results

The telepsychiatry and in-person groups were slightly different at baseline. Analysis of the data revealed no significant difference in coping abilities and psychiatric symptoms between those receiving face-to-face psychotherapy and those receiving telepsychiatry.

Interpretation

The quality and outcome of care was equal to in-person for the telepsychiatry in deaf patients. Since telepsychiatry does not compromise the quality of care, it is a good means of reaching out to members of the deaf community that cannot readily access mental health resources that meet their needs.

Intimate partner violence reported by two samples of deaf adults via a computerized American sign language survey

A computerized sign language survey was administered to two large samples of deaf adults. Six questions regarding intimate partner violence (IPV) were included, querying lifetime and past-year experiences of emotional abuse, physical abuse, and forced sex. Comparison data were available from a telephone survey of local households. Deaf respondents reported high rates of emotional abuse and much higher rates of forced sex than general population respondents. Physical abuse rates were comparable between groups. More men than women in both deaf samples reported past-year physical and sexual abuse. Past-year IPV was associated with higher utilization of hospital emergency services. Implications for IPV research, education, and intervention in the Deaf community are discussed.

Perspectives of people who are deaf and hard of hearing on mental health, recovery, and peer support

This qualitative study sought to better understand the experiences of deaf and hard of hearing individuals with accessing recovery-oriented mental health services and peer support via a focus group and interviews. Cultural brokers were used to facilitate culturally-sensitive communication with study participants. Findings indicate that access to adequate mental health services, not just recovery-oriented and peer support services, is not widely available for this population, largely due to communication barriers. Feelings of isolation and stigma are high among this population. Public mental health systems need to adapt and expand services for various cultural groups to insure recovery.

[Deaf patients in psychiatry]

Prelingual deafness has multiple and far reaching consequences for the development of language, cognition and the psychosocial dimension. Almost one of a thousand of the population is affected. Barriers in communication limit access to knowledge and participation in society. The use of sign language connects deaf people socio-culturally. This review shows discrepancies between high prevalence rates of mental health disorders with complex psychiatric challenges and barriers to mental health care. The UN convention on the rights of persons with disabilities obliges to counteract these discrepancies. Services with specialised signing professionals and the use of interpreters can improve access to mental health care.

Forensic nursing interventions with patients with personality disorder: a holistic approach

Research findings suggest that nursing assessment and care and psychotherapy of forensic patients with personality disorder should be based on a holistic approach that addresses a wide range of their needs. Such an approach should be in collaboration with patients, informal carers, and other professionals and informed by appropriate education, training, clinical supervision, and support. Holistic care includes areas (such as physical health, cultural, spiritual, and psychosexual needs) that are addressed to a limited extent in the literature on patients with personality disorder. Despite limitations in research evidence, findings suggest that some patients with personality disorder benefit from psychotherapies, sometimes facilitated by nurse-therapists, and therapeutic community principles. These interventions should take account of patients' cultural and spiritual needs and perspectives. Helping patients to manage anger has potentially positive consequences for their physical health, personal and work relationships, and other areas. Research is needed to consider how to deliver holistic care with limited resources and in organizations, such as prisons, with conflicting goals.

Assessment and treatment of deaf adults with psychiatric disorders: a review of the literature for practitioners

Many deaf individuals comprise a unique cultural and linguistic minority group. This article reviews the current research literature related to the evaluation, diagnosis, and treatment of culturally deaf individuals suffering from mental disorders. Appropriate psychiatric assessment and treatment requires that clinicians be sensitive to issues of language and differences in social norms and cultural values. Emerging trends in research indicate greater diagnostic specificity and a broader range of diagnoses being assigned in services that are specialized for the treatment of deaf people with mental health issues. Culturally sensitive evaluation and treatment involves a thorough assessment of language modality and language fluency, deafness/audiological history, and cultural identification. Failure to consider these factors during the mental status exam can lead to misdiagnosis. Important issues that confound differential diagnosis and psychiatric treatment of the deaf population are highlighted and discussed. Recommendations for the provision of culturally and linguistically appropriate care are provided.

Dialectical behavioral therapy informed treatment with deaf mental health consumers: an Australian pilot program

OBJECTIVE

This paper outlines the process of implementation of a dialectical behavioral therapy (DBT) informed treatment for Australian Deaf mental health consumers.

METHOD

The pilot project team members adapted DBT materials for the Australian Deaf population. Feedback was obtained from the pilot participants and modifications made during the pilot. Participant progress and therapeutic alliance were monitored using culturally valid tools.

RESULTS

The DBT informed therapy approach was well received by this target group, with the observation and self report of improved interpersonal skills and emotional regulation.

CONCLUSIONS

While labor intensive, the process of developing a DBT informed treatment program for Australian Deaf mental health consumers appears to be beneficial for this group. Culturally valid, objective measures of skill attainment need to be developed and further studies comparing different adapted therapeutic approaches would be useful.

Mental health of deaf people

Deafness is a heterogeneous condition with far-reaching effects on social, emotional, and cognitive development. Onset before language has been established happens in about seven per 10,000 people. Increased rates of mental health problems are reported in deaf people. Many regard themselves as members of a cultural minority who use sign language. In this Review, we describe discrepancies between a high burden of common mental health disorders and barriers to health care. About a quarter of deaf individuals have additional disabilities and a high probability of complex mental health needs. Research into factors affecting mental health of deaf children shows that early access to effective communication with family members and peers is desirable. Improved access to health and mental health care can be achieved by provision of specialist services with professionals trained to directly communicate with deaf people and with sign-language interpreters.