Region V Public Health Training Center 5/15/2019

Culturally Competent Public

Health Practice for Deaf and
Hard of Hearing Populations

Communication Access Center for

the Deaf and Hard of Hearing
Diana McKittrick
dmckittrick@cacdhh.org
810-250-7010

Statistics
• About 2 to 3 out of every 1,000 children in the United States are born with a detectable level of
hearing loss in one or both ears.
• More than 90 percent of deaf children are born to hearing parents.
• 70 percent of parents who have deaf children cannot communicate with their deaf child.
• Approximately 15% of American adults (37.5 million) aged 18 and over report some trouble hearing.
• Among adults aged 20-69, the overall annual prevalence of hearing loss dropped slightly from 16
percent (28.0 million) in the 1999-2004 period to 14 percent (27.7 million) in the 2011–2012 period.
• Age is the strongest predictor of hearing loss among adults aged 20-69, with the greatest amount of
hearing loss in the 60 to 69 age group.
• Men are almost twice as likely as women to have hearing loss among adults aged 20-69.
• One in eight people in the United States (13 percent, or 30 million) aged 12 years or older has hearing
loss in both ears, based on standard hearing examinations.
• About 2 percent of adults aged 45 to 54 have disabling hearing loss. The rate increases to 8.5 percent
for adults aged 55 to 64. Nearly 25 percent of those aged 65 to 74 and 50 percent of those who are
75 and older have disabling hearing loss.
• Roughly 10 percent of the U.S. adult population, or about 25 million Americans, has experienced
tinnitus lasting at least five minutes in the past year.
• About 28.8 million U.S. adults could benefit from using hearing aids.
• Among adults aged 70 and older with hearing loss who could benefit from hearing aids, fewer than
one in three (30 percent) has ever used them. Even fewer adults aged 20 to 69 (approximately 16
percent) who could benefit from wearing hearing aids have ever used them.

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Reactions of people involved in a

typical medical related interaction

• Reaction of the Deaf/HH/DB person

attempting to obtain health care services
• Reaction of front line medical personnel
when approached by Deaf/HH individuals
• Reaction of Physicians and Nurses providing
health care services

Labels We See: We Use:

• Deaf • Deaf
• Deaf-Mute
• Hard of Hearing
• Deaf and Dumb
• Hearing
• Hard of Hearing
• Almost Hearing
• Hearing Challenged
• Dummy
• Mute
• Hearing Impaired
• Speech Impaired

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What is the difference?

Deaf
The individual is part of the deaf community, uses
American Sign Language and embraces the
concept that deafness is normal way of life.

deaf
The individual is not part of the deaf
community. Perceives self as flawed and need
to be fixed. Views self as disabled.

Different groups within the

Deaf Community Influences
Communication Approaches
• Generational Deaf
• Deaf who attended state residential school for the deaf
• Deaf with hearing parents that have not learned to sign or can sign
• Ethnic groups- Black Deaf, Asian Deaf, Hispanic Deaf, etc…
• Hard of Hearing
• Oral Deaf
• LGBTQ
• Senior Citizens
• CODA/KODA
• Late Deafened
• Cochlear Implanted Deaf
• Limited Language Deaf
• Deaf with other disabilities
• DeafBlind

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Cultural Tendencies

• Starts conversation from general to specific

• Long good-byes
• Always let people know where you are going
• Hugging/Touching
• Blunt/Straight talk
• Visual noise
• Sharing information
• Whispers

Deaf People Can:

Get married

Can drive

Raise hearing children

Can work/have jobs/careers

Handle their own finances

Have a social life

Make phone calls to hearing friends,
family members or businesses

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Barriers that Deaf

Community face
• Inadequate education
• Low reading skills
• Low health literacy knowledge
• Service providers not willing to provide
effective communication
• Discrimination
• Audism
• Paternalism

Language and
Communication

• American Sign Language (ASL) is the

preferred language used in North America
• ASL is not universal
• ASL has regional variations
• ASL is a living language and
additions/changes occur over time
• ASL is a visual language with its own
syntax and grammar

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Different Types of Sign

Language Modalities
Manually Coded English (MCE)
• Created by hearing people to make English visible
for students to improve their reading and writing
skills
• It is not a language
• Different types of MCE are: SEE, SEE1, LOVE,
CASE, Rochester Method
• PSE - Pidgin Sign Language/Contact Sign
Language
• Rochester method- all fingerspelling except for
sign “AND”

Degree of competency in
use of English and ASL

• Balanced bilingual - equally competent in

English and ASL
• ASL Dominant - has skills in both but ASL use
is preferred and stronger than English
• English Dominant - has skills in both but
English word order is preferred and
proficient in use of written English
• Minimal Language - does not have skills in
English or ASL - illiterate

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Comparison of English and ASL

ASL: English:
Woman leave Did the woman
book? leave book?

ASL: English:
Woman leave The woman didn’t
book (NEG) leave her book.

ASL: English:
Woman leave The woman left
book (NODDING) her book.

Translation Activity
Limited Language User
• Earl John HOUSE WHITE LOOK

• Earl John BOOK PLEASE OK?

• M-A-R-Y FRIDAY 6:00 PARTY YES OK?

• SCHOOL FINISH Earl John GO GO GO YES.

• TALK CURVE CURVE ALL TIME NOT STRAIGHT

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Communication Methods
Used by Service Providers
• Writing back and forth
• Lipreading
• Using an “signer” instead of Certified
Interpreter
• Using family to interpret
• Waiting until the last minute to call for sign
language interpreter
• Video Remote Interpreting (VRI)
• Onsite Certified Interpreter

Lack of Effective
Communication Access
Communication difficulties

Altered Health care utilization

Misunderstanding about medical condition

Misunderstanding of treatment process

Misunderstanding of medication use

Sense of unease by both parties

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Risk to the Deaf/HH/DB

Individual

• Error in understanding all symptoms

• Error in decision on diagnosis

• Error in development of appropriate

treatment plan

• Non compliance of treatment plan

• Choice of making informed decision

about health care is compromised

Potential Problems
• Possible return to emergency room/primary
care provider for same problem.
• Non compliance with treatment plan
• Cost of repeat visits
• Time wasted
• Patient and doctor relationship and trust
issues
• Possible lawsuit for failure to provide
accommodation
ADA- Americans with Disabilities Act
Section 504 Rehabilitation Act
PA204 amended 2007 (Deaf Person’s Interpreter Act)

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Communication
Strategies Typically Used
• Sign Language Interpreter on site

• Video Remote Interpreting

• Writing back and forth

• Speechreading/lipreading

• Visual drawings/pictures

Michigan Interpreters
PA 204 amended 2007
(known as Deaf Individual
Interpreter Act)

• Must be registered with LARA

• Must Have Interpreter Certification
• Must have Medical Endorsement to
do medical/mental health
interpreting assignments.

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How Do You Know?

• Ask to see Identification card
issued by State of Michigan
which has their credentials and
endorsements

• Use Michigan Online

Interpreter Directory

• Use of waivers - typically

indicate underqualified
interpreter

• Responses to questions not

make sense

Do
• Talk directly to the Deaf/HH/DB Individual.
• Talk at a normal pace
• Realize that head nodding does not mean
agreement or understanding of what was
conveyed
• Realize that the interpreter may ask for
clarification to ensure full understanding of
what was said
• Maintain eye contact throughout the
interaction

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Don’t

• Ask the interpreter not to interpret what you

said
• Say “Tell him” or “Tell her”
• Ask the interpreter to give information about
the deaf/hh individual.
• Continue if you see that communication is
not effective between the interpreter and
deaf individual - How do you know?

Goal

• Positive experience for the deaf/hh/db

patient and family
• Appropriate medical diagnosis and
treatment given
• Better compliance with treatment plan
• Reduce return visits for the same problem

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Questions???

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