Psychosocial Considerations in Serving Individuals who are Deafblind Michelle Niehaus, LCSW Program Administrator Deaf and Hard of Hearing Services KY DBHDID (502) 782-6181 (V) or (502) 385-0460 (VP) Meet Paul Paul is in his mid-thirties. He lives in a Midwestern city where he has 24-hour staff in is own home. He has been Deafblind since birth and attended excellent specialized schools. Paul enjoys building things and works at a Pizza Hut where he is exceptionally fast at putting together boxes. He visits his parents twice a month. Paul communicates with sign language in close vision. He also has a wall-sized tactile schedule. When agitated, he will sometimes bite his hand or bang his head. He
loves being outside in all weather and looks forward to his walks in local parks. His father was recently diagnosed with end stage cancer and doesnt want Paul to know. The father is not expected to live through the year. Meet Pete Pete is in his mid-fifties. He has considered himself Deaf-Blind since his 20s. Due to deteriorating health, he now uses a wheelchair. His friends are concerned that he will no longer use Tarc 3 to visit them. He spends a lot of time online. Pete had been a faithful in going to mass but stopped about three months ago. Meet Sam Sam is in his 20s. He is a successful businessman who wears a unilateral hearing aid. Sam noticed recently that his peripheral vision is getting blurry. He also has had some balance issues. Sam is getting concerned
about driving which is a problem since weekend travel is one of his favorite activities. He identifies as gay and does not feel comfortable in the local community due to his work. He goes to the doctor to see if his allergies may be the reason for the balance and vision issues. Sam is diagnosed with Ushers Syndrome. What do we perceive? Psychosocial Considerations: Etiologies of deafblindness that may also lend themselves to mental health issues (ex. Congenital Rubella Syndrome) Strengths and Skills prior to loss of hearing and/or vision Compounding issues Diagnoses Related Life Happening Access to and Willingness to Seek Help
Which individual(s) may have the hardest time adjusting? What support does he have? What communication challenges may he face? What concerns do you have looking at employment? What diagnoses would expect this individual to have? What warning signs may you look for as an indication to refer? TABLE QUESTIONS Individuals who are Deaf-blind The deaf-blind population is heterogeneous due to a myriad of factors: etiology, age of onset, degree of vision and hearing loss, communication preference, educational background, life experience, cultural background and strengths & ability. (Model State Plan 08)
Mental Health and Deafblindness Common Diagnoses Seen Ask Yourself Was the professional qualified to make that diagnosis? On what basis was it made? (Standardized measures?) If the diagnosis seems accurate, does the treatment approach meet the individuals
needs? Is the treating professional able to make the needed adaptations to treatment? Adjustment Disorder Depression Bipolar Obsessive Compulsive Disorder Substance Use Disorder Intermittent Explosive Disorder Post Traumatic Stress Disorder (PTSD) Others? Beware of the Single Story! https:// www.ted.com/talks/chimamanda_ad ichie_the_danger_of_a_single_story
https://www.deafcounseling.com/exactly-inter sectionality / Adjustment Disorder The DSM-5 defines adjustment disorder as the presence of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s) (American Psychiatric Association, 2013) One or both of these criteria exist: Distress that is out of proportion with expected reactions to the stressor Symptoms must be clinically significantthey cause marked distress and impairment in functioning In addition, these criteria must be present: Distress and impairment are related to the stressor and are not an escalation of existing mental health disorders The reaction isnt part of normal bereavement Once the stressor is removed or the person has begun to adjust and cope, the symptoms must subside within six months
Stages of Grief and LossTwo Models Kubler-Ross Denial Anger Bargaining Depression Acceptance Ziezulu & Meadows Spectrum of Emotional Responses Adapting to Secondary Losses Confusion of Identity Acceptance Need for Professional Acceptance and Information
Zitters Multi-Dimensional Assessment Communication Culture Clinical Resources What would a typical adjustment look like? Are there any models (peer supports) to assist? Hint: KA Adjustment and Grief are usually not one and done QUESTIONS TO CONSIDER The Ripple Effect: Impact on Family Denial of the issue can delay help seeking Disagreement on how to proceed can play out as resistance or non-compliance with treatment or other services Real communication issues emerge if this is a progressive loss An Identified Patient and his/her issues will
have an effect on all other members of the family system Prior to the diagnosis, the family had established norms, roles, routines, and expectationsthese will be altered depending on how adaptation by all family members occurs Dealing with the individual with hearing and vision loss is only one part of what a family must do They still have jobs, financial obligations, etc. Tendency to exclude the individual and make decisions for, for Protecting individuals rather than giving opportunities to experience then succeed or fail Depression According to the DSM-5, the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure. Depressed mood most of the day, nearly every day
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down). Fatigue or loss of energy nearly every day. Feelings of worthlessness or excessive or inappropriate guilt nearly every day. Diminished ability to think or concentrate, or indecisiveness, nearly every day. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. New Specifiers in the DSM-5 With Mixed Features This specifier allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the full criteria for a manic episode. With Anxious Distress The presence of anxiety in patients may affect prognosis, treatment options, and the patients response to them. Clinicians will
need to assess whether or not the individual experiencing depression also presents with anxious distress. Anxiety and Deaf-Blindness Acute Concerns Loss of control Fear of social situations Physical unease in new environments Adapting to the use of equipment Some etiologies have implications related to behavioral health Ex. Rigidity in Congenital Rubella Syndrome Some coping skills may present as diagnosable issues Ex. Paul
Long-Term Considerations Withdrawal from family and friends Internalization Medication may take the edge off, but new skills will need to learned and adaptations to the environment implemented How Do You Know When You are in a Crisis? Individual Family and Friends Community or Communities at Large
Learning to Listen with the Heart as exemplified in Michael Harveys work Suicide Risk: IS PATH WARM? Know the Suicide Prevention Resources QPR Question, Persuade, Refer Training Available through DBHDID National Hotline: 1-800273-8255 Crisis Text Line Hotlines by County: https ://dbhdid.ky.gov/crisisnos. aspx Monitoring for Abuse History
Physical and Substance Abuse Sexual Abuse Deaf 1/ 7 vs. children 1/10 has area2-3 history timesofmore substance likely to usebe abused than hearing children Perpetrators Higher % endoften up intarget hospitals people or jail
with hearing loss thinking they wont tell 60-85% Traditional of women Treatment withdoes disabilities not work have as well experienced with Deafdomestic (stigma, violence support, access, English) Variations Most 12 Step of Power Meetings andare Control
not accessible / Lack of education on what constitutes abuse Any Self Help attempt groups to impose in their your structure will on cananother be exclusive is an act of violence Mahatma Gandhi High Sponsors incidence arentoffamiliar PTSD with Deaf culture Lack Minnesota
of understanding Chemical Dependency of Deaf culture Program in APSforcases the Deaf and Hard of Hearing as resource Lack of accessibility to basic services Consider the Impact of Individual and Systems Trauma on Interactions Past Trauma Can Affect Interpretation of Current Events For Many Individuals, Medical Experiences Have Been Traumatic ACES: Adverse Childhood Experiences Language Deprivation Syndrome: Another Consideration in Trauma Informed Care
Overview of Language Deprivation Syndrome Indicators of Language Deprivation Syndrome Language dysfluency Fund of knowledge deficits Disruptions in thinking, mood, and/or behavior. See Full Article: Hall, W.C., Levin, L.L. & Anderson, M.L. Soc Psychiatry Psychiatr Epidemiol (2017) 52: 761. https://doi.org/10.1007/s00127017-1351-7 For more in depth information, see Dr. Guptas lecture at Brown University: https://www.youtube.com/watch?v=8yy_K6VtHJw Substance Use A 2018 study published in the American Journal of Preventive Medicine found
an increased risk of prescription opioid use for those with hearing loss aged 1834. For those aged 35-49, hearing loss increased the risk of both alcohol and prescription opioids. (The Relationship Between Hearing Loss and Substance Use Disorders Among Adults in the U.S. 2018. American Journal of Preventive Medicine 56(4):586590. Michael M. McKee, MD, MPH,1Michelle A. Meade, PhD,2Philip Zazove, MD,1Haylie J. Stewart, BA,3,4Mary L. Jannausch, MS,3,4Mark A. Ilgen, PhD.) A 2018 Survey of KY School for Alcohol and Other Drug Study attendees revealed the following barriers: Transportation (47.4%) Literacy / Appropriate Curriculum and Approaches (40.4%) Finding Peers in Recovery (38.6%); Finding a Job (35.1%) Paying for Treatment (33.3%). Substance Use Disorder Challenges Hope In each of the past five state
fiscal years, 5-11 Deaf-Blind individuals sought SUD treatment in CMHCs No specialized CADCs in Kentucky Adaptations of treatment available for the Deaf community are highly visual DBHDID has a new Certified Peer Support Specialist who is Deaf! DBHDID will pay for interpreters in CMHCs, 12 Step meetings / Mutual Aid Groups Learning Collaborative with the Technology Transfer Center (free webinars!) Eyes on Hope Taskforce providing Deaf Sober Socials and assisting with training
opportunities statewide How does that work for individuals with vision loss? Do providers adapt their protocol to be fully accessible? Referral for Substance Use Treatment: Recognizing the Stages of Change Precontemplation Contemplation Preparation Action Maintenance (and Relapse Prevention)
What may happen if the individual is one place n the spectrum and their significant other is somewhere else? Taking a workshop on Motivational Interviewing (MI) could be very helpful for you! Referral Considerations Generalized Providers Specialized Deaf Mental Health Providers Available at Centerstone, New Vista, and Cumberland River May travel outside their region as able Must be able to meet the individualized and possibly variable communication needs of the individual
Pathways 11 Mountain [email protected] 270- 765-2605 x1143 502-435-4121 Lets Revisit our Friends Paul Complicated Grief Allowing life experiences Creative ways to address grief and loss Pete Reducing isolation through community involvement KADB Faith Communities Drawing on his strengths Monitoring for increased anxiety or depression including agoraphobia
Sam Adjustment to diagnosis of Ushers Syndrome Skill building as needs change Maintaining as much independence as possible Recognizing multiple identities / changing identities / intersectionality Keep the Conversation Going! Michelle Niehaus, LCSW Program Administrator Deaf and Hard of Hearing Services KY DBHDID (502) 782-6181 (Voice) (502) 385-0460 (VP) [email protected]
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