Deaf and Hard-of-Hearing People
Abstract and Keywords
Effective social work practice with deaf and hard-of-hearing people requires a unique, and diverse, collection of knowledge, values, skills, and ethical considerations. Salient issues among this population are language, communication, and educational choices, interpreting, assistive devices, cochlear implants, genetics, culture, and access to community resources. Competencies at micro, mezzo, and macro levels with a deaf or hard-of-hearing population include knowledge of the psychosocial and developmental aspects of hearing loss, fluency in the national sign language, and an understanding of deaf cultural values and norms. In the United States, the use of American Sign Language (ASL) is the single most distinguishing factor that identifies deaf people as a linguistic minority group. This entry presents an overview of the practice competencies and intervention approaches that should be considered in working with deaf and hard-of-hearing people, their families, communities, and organizations. It introduces the knowledge base, diversity in community and cultural orientations, social constructions, and international perspectives, current research and best practices, interdisciplinary connections, trends, challenges, and implications for effective social work practice with this population. An integrative strengths-based transactional paradigm is suggested.
Deaf and hard-of-hearing people represent the wide heterogeneity of any society in the world, including diversity in socioeconomic status, race, sexual orientation, ethnicity, and religious preference. People who are deaf or hard of hearing are also diverse in terms of the degree of decibel loss, identification with the deaf community, and personal preferences in use of available technology such as hearing aids, assistive communication devices, and surgical procedures to improve hearing through cochlear implants. In spite of the diversity of individuals within this population, there are distinct commonalities that justify understanding the deaf and hard-of-hearing population as a culturally diverse group, as well as a population at risk. A review of the social work literature reveals a dearth of discussions about the deaf and hard-of-hearing population and the deaf community and culture.
Definitions and Demographics
The term deaf and hard of hearing replaces terms such as hearing impaired and is used broadly to identify anyone with a hearing loss. A person may self-identify as either “deaf” or “hard of hearing” based on any number of factors, including educational placement, family background, decibel loss, and cultural values. A hard-of-hearing person may have a mild to moderate hearing loss and may or may not identify with the Deaf community. “Hard of hearing” may also be the preferred social identification for individuals with severe to profound hearing loss, such as late deafened or older adults. The literature uses the word Deaf with either uppercase spelling or lowercase spelling, depending on cultural identification. The lowercase deaf refers to people who identify themselves as having a moderate to severe hearing loss as measured on an audiogram and live their lives without much contact with deaf people who sign. The uppercase Deaf refers to individuals born deaf or who became deaf later in life and use their society’s national sign language and whose primary social networks and allegiances include the Deaf community (Kusters & De Meulder, 2013; Ladd, 2003). Thus, deaf and hard-of-hearing people may or may not affiliate with Deaf culture, and this affiliation may change through the life course (Leigh, 2009; Oliva, 2004; Sheridan, 2008).
Demographic information on the deaf and hard-of-hearing population varies according to the researcher’s definition of deaf and hard of hearing as well as the sources used. A widely cited demographic source from the Gallaudet Research Institute reveals that 20,292,000 people, or 8.6% of the U.S. population, are deaf or hard of hearing (Holt & Hotto, 1994). Of this number, 1.8% are children 3–17 years old, and 29.1% are older than 65 years. Researchers should use caution when reporting demographic data on deaf and hard-of-hearing people and specify how the terms are defined. The data available, however, indicate a sizable deaf and hard-of-hearing population that is often overlooked in research studies, social service programs, and even in the U.S. Census (Disability and the 2000 Census, 2007).
Social Constructions of Deaf People
There are two opposing social constructions of deaf people that have been the subject of professional debate for hundreds of years commonly referred to as the medical model and the cultural model (Higgins, 1980; Lane, 1999; Padden & Humphries, 1988; Sheridan, 2001; White, 1997; Horejes, 2012). The medical model has been the dominant paradigm among researchers and health professionals in Western societies. This model emphasizes the audiological aspects of hearing loss, technical and surgical advances to eradicate deafness, and the rehabilitative notion that medicine and science can “cure” deafness. It also emphasizes the pathology of deafness and the deaf person’s deficiencies in language and literacy, cognition, mental health, and psychosocial development. Educational policies for deaf children have been rooted in this model, and an oral philosophy in education, which disavows the use of sign language and emphasizes mainstream education through lip reading and use of hearing aids and cochlear implants, has dominated the educational debate for deaf and hard-of-hearing children. Role models for deaf children are usually hearing persons or oral deaf adults who do not use sign language. The medical model has largely been promoted by hearing professionals (Neisser, 1983) and by the Western belief that bodily perfection is a virtue (Crittenden, 1993). More recently, the concept of “Deaf-gain” (Bauman & Murray, 2008, 2010), the opposite of “hearing loss”, has been introduced as a positive representation of deaf people as a diverse entity.
The cultural model portrays Deaf people from a sociocultural and human diversity framework where deafness is viewed as a human difference and the Deaf community is seen as a linguistic minority group with a rich, vibrant culture and sign language. The linguistic studies of William Stokoe (1960) provided legitimacy to American Sign Language (ASL) and spawned a popular and growing field of sign language studies. More than 35 states recognize ASL as a language of study in public schools. A growing number of colleges and universities have established departments of deaf studies and Gallaudet University established the first Master’s degree program in Sign Language Teaching in 2011. The cultural construction is viewed as less oppressive to deaf people, and, in the social work tradition, emphasizes strengths and empowerment.
The Deaf Community and Deaf Culture
The most distinguishing characteristic of deaf culture in the United States is the value placed on ASL and the acceptance of a set of values, attitudes, and beliefs about deaf people and the deaf community (Padden & Humphries, 1988). Deaf people place a high value on educating deaf children at state residential or day schools, since it is there that a deaf heritage is learned, classroom teachers use ASL, and there are deaf adult role models. Approximately 10% of deaf children have deaf parents. Deaf parents are commonly pleased with the diagnosis of deafness in their infants, often puzzling their doctors (Lane, 1993; Schlesinger & Meadow, 1972). Deaf adoptive parents more often express a desire to adopt deaf children (White, 2000). One’s hearing loss is less important than one’s attitude of acceptance of “being deaf in the world” or what Ladd (2003) calls “deafhood.” Certain behaviors such as flicking a light switch to get one’s attention, raising and shaking hands in the air for applause, and standing at a greater distance when communicating in ASL are accepted cultural norms. The intermarriage rate in the deaf community is perhaps the highest of any disability group, with 85–95% of deaf people marrying a person who is deaf (Schein, 1989). Formal organizational structure is also a salient feature of deaf culture, with an abundant network of local, state, and international organizations of, by, and for deaf people. As with any culture, there are material goods that distinguish deaf culture; these include mobile phones with text and video communication features, flashing or vibrating alarm clocks, baby crier and flashing phone signalers, strobe smoke detectors and doorbell lights, and video relay service offered from various companies under Federal Communication Commission regulations. Deaf culture includes a rich body of literature, folklore, poetry, theater, and art, as well as formal sports organizations and events, such as the “Deaflympics” (http://www.deaflympics.com/). In the 21st century, deaf blogs, chat rooms, videoblogs, and video phones keep the community connected.
Diversity and Population at Risk
The deaf community is a diverse one representing the microcosm of the society of which they are a part. The same is true for hard-of-hearing people. Thus, there are a growing number of separate formal organizations by and for deaf and hard-of-hearing people from the LGBT community, women’s groups, people of color, senior citizens, deaf–blind people, and people with disabilities to promote equal rights and empowerment. Members of these groups face double stigma and marginalization.
The deaf population is considered a “low incidence” population; therefore, as a group, they are often overlooked in the development of policies, programs, and services because of communication barriers. The Americans with Disabilities Act of 1990 (1991) empowered deaf and hard-of-hearing people with equal rights to education, employment, health, and social services. However, these hard-earned legal rights and access to these services are still being challenged in the courts. The National Association of the Deaf regularly files lawsuits on behalf of deaf plaintiffs who are denied sign language interpreters in health, education, and legal settings, as well as cases involving police brutality and imprisonment without sign language interpreters (Estrada, 2006). Deaf and hard-of-hearing people must educate and advocate for access to social benefits such as captioned television and films, emergency telecommunication broadcasts, health and mental health care, education, and interpreting services on a daily basis (Sheridan, 2008; White, 2006). Deaf people who want to become adoptive parents face discrimination in accessing pre- and post-adoption services even when research shows positive outcomes for deaf-parented adoptive families (White, 2000). Deaf people face a higher rate of unemployment and underemployment and lower incomes than does the general population (Watson, Jennings, Tomlison, Boone, & Anderson, 2008). Social workers who are deaf or hard-of-hearing face barriers accessing the profession and must continuously educate and collaborate with professional organizations to improve access (Sheridan, White, & Mounty, 2010).
In addition to access issues, the history of deaf people is a story of marginalization, language oppression, diminished educational choices, discrimination, and devaluation of ASL (Baynton et al., 2007; Lane, 1984; VanCleve & Crouch, 1989). Models of culturally affirmative mental health services are available (Glickman, 2009, 2013;Glickman & Harvey, 1996; Myers, 1995), yet the general health and mental health disparities among this population are ever present (Glickman, 2013). There is evidence of higher incidence of physical and sexual abuse of deaf children (Hamerdinger & Hill, 2006; Lomas & Johnson, 2012), lack of access to health care, legal and social services, and vocational assistance (DuBow, 2000), and generally lower educational achievement and literacy rates (Lane, 1999; Marschark & Spencer, 2011). These lower educational achievement and literacy rates are not a reflection of the capabilities of deaf and hard of hearing people per se, but are affected by systematic flaws in educational policy, institutions, communication, and academic achievement testing (Horejes, 2012).
International Deaf Community
The global prevalence of disability is approximately 15% of the world’s population, an increase in previously reported figures. This rise in the global disability population may be due to longer life spans, more accurate ways of measuring disability, and the spread of chronic diseases. The barriers to full inclusion and equality that people with disabilities, including deaf people, face are inadequate policies and standards, negative attitudes, deficiencies in services and service delivery, inadequate funding, lack of access, lack of consultation and involvement, and lack of data (World Health Organization, 2011). The United Nations has established the Millennium Development Goals (MDG), yet people with disabilities are largely overlooked in these goals (Groce & Trani, 2009).
Deaf communities exist in every country of the world, and each country has its own sign language, even when the spoken language is the same. For example, while the United States and United Kingdom share the same spoken language, their sign languages are very different. Most deaf communities have established local, state, and national organizations. The World Federation of the Deaf (WFD) is a nongovernmental international body recognized by the United Nations representing 127 national deaf associations and over 70 million deaf people throughout the world. WFD works to improve human rights, equal access to information and services, recognition of national sign languages, and education of deaf people worldwide (Gannon, 2011; World Federation of the Deaf, 2007). WFD has also been a key player in drafting the United Nations Convention on the Rights of People with Disabilities (CRPD). This important treaty mentions sign language eight times so that the linguistic rights of deaf people are protected. This is the first international treaty that recognizes deaf people worldwide as a linguistic and cultural group, using the cultural model (retrieved from http://www.nad.org/issues/international-advocacy/crpd/). Although over 130 countries have ratified the treaty by 2013, the United States Senate failed to ratify it by a two-thirds majority in December 2012.
Deaf communities throughout the world maintain their existence through a common sign language, a cultural identity, and an organizational structure that provides social affiliation and empowerment. Cultural affiliation and identity serve as a buffer to a sense of alienation often perpetuated by social exclusion and reduced access to the goods and services of society. Schein (1989) proposed a theory of deaf community development and lists three criteria that explain how deaf communities perpetuate: alienation from the larger hearing society, affiliation with other deaf people and their organizations, and sustainability with a critical mass. Advocacy is an ongoing endeavor because deaf people throughout the world face discrimination, oppression, and infringement on their human rights.
For deaf people in many developing nations, the unemployment rate is three times higher than the national average and only about 20% of deaf children attend school (Joutselainen, 1991). Recent data from the World Health Organization (2011) show little improvement in educational attainment of people with disabilities. In some countries, deaf people are not allowed to get a driver’s license, marry another deaf person, or register to vote (Joutselainen). The WFD reports that 80% of the 70 million people in the world live in developing countries, where their rights to access to communication, use of a national sign language, equal participation in society, and opportunity to an education are largely ignored (World Federation of the Deaf, 2007). Deaf people themselves are serving in many capacities in international deaf communities with such organizations as AmeriCorp, Discovering Deaf Worlds, Global Reach Out, and the Peace Corps. The experiences and contributions of Returned Peace Corp Volunteers are documented and portrayed in an exhibit at Gallaudet University (Making a difference: Deaf Peace Corp Volunteers, 2013). Social work with the international deaf community is sorely needed.
A Model for Social Work Practice with Deaf and Hard-of-Hearing People
Effective social work practice with deaf and hard-of-hearing people, their communities, and organizations involves commitment and competencies of three dimensions: (a) generalist social work practice, (b) competencies that qualify them to work with this unique multicultural population, and (c) a commitment to the social justice values of the profession, the community they serve, and theoretical approaches promoting empowerment and strengths. These three dimensions form an integrative strengths-based transactional paradigm for social work practice with deaf and hard-of-hearing people. Originating from the strengths-based transactional deafness paradigm proposed by Sheridan (1999) coupled with an integrative model (Nichols, 1995), this paradigm allows social workers to synthesize any number of theoretical approaches deemed appropriate to the cases at hand. This is in keeping with the social justice values of the profession, the strengths perspective (Saleebey, 2002), and empowerment. The population of deaf and hard-of-hearing people is diverse in racial, ethnic, cultural, gender, and spiritual realities; therefore, multicultural competencies are also necessary.
Practitioners should be mindful of audism, the individual, institutional, and metaphysical aspects of oppression that support the notion of the superiority of people who can hear (Bauman, 2004). Audism is present in the lives of many deaf and hard-of-hearing people, their families, and communities (Bauman, 2004). Application of a strengths approach to practice that examines the capabilities, resiliencies, resources, and talents of deaf and hard-of-hearing people may counter any internalized oppression. Social workers should also be familiar with the unique biopsychosocial, cultural, linguistic, and developmental factors. Additionally, researchers should be mindful of unique communication and cross-cultural ethics (Brice, Leigh, Sheridan, & Smith, 2013; Gournaris & Aubrecht, 2013; Leigh & Gutman, 2010; Pollard, 2002). Social and organizational policies should take the communication and cultural concerns of deaf and hard-of-hearing people into consideration, especially as these relate to access and culturally appropriate provision of agency services and implications and important concerns for communication. Agencies would do well to employ and consult with social workers who are deaf, hard of hearing, or hearing with the necessary competencies and qualifications to provide consultation related to the provision of services to deaf and hard-of-hearing people.
Investigation into the effectiveness of theoretical applications to assessment and intervention with deaf and hard-of-hearing people is just now beginning (Glickman, 2009; Glickman & Pollard, 2013; O’Hearn, Pollard, & Haynes, 2010). Service voids exist because of the still developing number of practitioners possessing the competencies necessary for effective practice with this population. Because of the voids in specialized social work practice arenas with this population, many social workers find that they must use a generalist approach allowing for the application of a variety of social work roles, theories, assessment, and intervention techniques at multisystem levels.
The aim of this integrative strengths-based transactional paradigm is empowerment of deaf and hard-of-hearing people in systems of all sizes. This approach fits a person-in-the-environment perspective which values transactions between diverse individuals and others that enhance dignity, individuality, self-determination, and social justice.
Theoretical Considerations for an Integrative Approach
The development of social work practice theories and theories of human behavior and the social environment occur within sociocultural, political, and temporal contexts (Sheridan, 2008). Social workers working with deaf and hard-of-hearing people must critique the contextual utility of these theories for practice with these populations.
Considering that deaf and hard-of-hearing people may have fewer opportunities for environmental stimulation enhancing development (Sheridan, 2011), it is inappropriate to draw conclusions about successful development based on comparative observations with hearing people. Like anyone else with sufficient opportunities for environmental stimulation, deaf and hard-of-hearing people grow to become fully functioning actualized, healthy adults. These opportunities include language, communication, information, physical and emotional care, appropriate educational placements, ample opportunities for socialization, and critical attachment experiences. From an existential perspective, the survival and transcendence of an often inaccessible and oppressive environment represent a collective and individual strength of deaf and hard-of-hearing people (Sheridan, 1995, 2008, 2011).
Little empirical research has been conducted to explore the biopsychosocial development of deaf persons. Current longitudinal life course research depicting, to date, the experiences and perceptions of the lifeworlds of deaf children and adolescents is an attempt in this direction (Sheridan, 2001, 2008). This research is framed in a symbolic interactionist and an ecological perspective of development, wherein the deaf person is observed in the biopsychosocial and temporal contexts of the environment in an effort to understand the deaf perspective of self and others in their lifeworlds (Sheridan, 2008). Naturalistic research methods (Lincoln & Guba, 1985) give voice to the developmental perspectives and experiences of deaf and hard-of-hearing people (Sheridan, 1996, 2001). The study of Becker (1980) showing the adaptive strengths of older deaf adults, and the developmental research of Sheridan (2001, 2008) are examples.
A few examples of applications of existing developmental theories to the experiences of deaf and hard-of-hearing people are Harvey’s use of an ecosystems model to examine critical points in the life cycle of deaf and hard-of-hearing persons from birth through old age (Harvey, 2003), applications of Erikson’s psychosocial theory to the development of deaf and hard-of-hearing people (Schlesinger & Meadow, 1972; Sheetz, 2001), and psychodynamic applications to assessment and practice (Cohen, 2000, 2012), and identity development (Glickman, 1996; Holcomb, 1997). Leigh (2009) provides an extensive discussion of the research on identity development among diverse groups of deaf and hard of hearing people. Schirmer (2001), Moores (2001), Sheetz (2001), Andrews, Leigh, and Weiner (2004), and seven chapters in Marschark and Spencer’s (2010, 2011) Oxford Handbook of Deaf Studies, Languages, and Education have reviewed cognitive correlates and implications of the developing deaf person important in education, language development, and social and psychological functioning. Sheridan (1995, 2001, 2008) sees Frankl’s (1969) existential logotherapies having potential for understanding the meanings that deaf and hard-of-hearing people ascribe to situations in their lives and for understanding and promoting transcendence over disruptive personal and social conditions. The symbolic interaction theory of Mead (1934) is useful as a framework for understanding the development of self-perceptions through interaction with others at various systems levels.
Research into the practical application and effectiveness of intervention theories is even more limited (Glickman & Pollard, 2013). However, practitioners are increasingly aware of the need to focus on the impact of the deaf or hard-of-hearing person’s environment as opposed to their personal characteristics (Sheridan, 2008).
The isolation of deaf people in a larger hearing society is believed to lead deaf people to respond to an imposed “outsider” status by forming their own identificational community (Higgins, 1980). Community membership is attained through shared experiences, identification with, and participation in, the activities of other deaf people (Wax, 1997). The diversity of deaf people leads to the development of smaller deaf communities (Woll & Ladd, 2011). Social change occurs through the process of symbolic interaction; as we act upon the interpretations and meanings we derive from situations, we contribute to the development of our cultures and societies (Sheridan, 2008). Wax (1997) suggests that social workers working with deaf communities must adopt “a reconstructionist (Ivey, 1993), or coevolutionary (Harvey & Dym, 1988) approach whereby practitioners and community members alike need to minimize assumptions about each other and negotiate a consensus of values or meanings as groundwork for intervention” (p. 683).
An ecosystems approach to assessment and intervention has been applied to deaf and hard-of-hearing people (Harvey, 2003). Although not empirically based, this model offers an understanding of development of deaf and hard-of-hearing people in the context of their ecosystems and discusses applications for psychotherapeutic interventions.
Practice Competencies and Intervention
The Council on Social Work Education has established ten core competencies and 41 practice behaviors for all social work education programs (Council on Social Work Education, 2008). In addition to these, mental health and social service professionals must possess a specialized set of competencies for effective practice with deaf and hard-of-hearing people (Brice et al., 2013; Gallaudet University MSW Program Handbook, 2012–2013; Levine, 1977; Myers, 1995; Pollard, 1992, 1994; Sheridan, 1988, 1993, 1999). Individual and collective values of the deaf community and deaf and hard-of-hearing people and their organizations and a commitment to an empowering and participatory approach to practice and self-determination are necessary.
Social workers should be aware of a client’s perspective of self as a deaf person; if they see themselves as a member of the deaf community or as a person with a disability, as this has implications for practice. While deaf and hard-of-hearing people will seek the services of social workers for any of the same reasons that a hearing person would, their different self-contexts may suggest divergent intervention strategies. Social workers working with recently deafened individuals may need to focus on options for education, communication, including assistive technologies, and language, family and systems adaptation, and individual and family emotional responses to the loss of hearing. An affiliation with the Deaf Community and the facilitation of a change to a cultural orientation may be considered an option for intervention (Leigh & Lewis, 2010; Wax, 1993, 1997). On the other hand, the social worker assisting an individual who lives within the deaf community, and who takes being deaf for granted, must be prepared for cross-cultural practice and communication.
Deaf people are visually oriented rather than auditory oriented (Bahan, 2008; Christensen & Delgado, 1993; Ladd, 2003; Lane, Hoffmeister, & Bahan, 1996). This means that visual communication in the practice relationship, in agency communications, and in the personal (for example, arts, recreation, and social relationships) and vocational or professional lives of deaf people is essential.
Minimum standard competencies for mental health professionals have been discussed in a number of sources and include expressive and receptive abilities in the full range of communication and linguistic competencies used by deaf and hard-of-hearing people, including ASL and proper utilization of sign language interpreters. Effective communication may be the single most important factor for successful social work practice with this population. There are, however, several additional critical components, including knowledge of
1. Options in educational placement and communication and implications for the individual and family systems;
2. Awareness of normative behaviors, language, and cognition and implications for culturally affirmative biopsychosocial mental status assessment and intervention;
3. Psychosocial, identity, developmental, and multisystemic issues in human behavior and the social environment across the life cycle;
4. Current research pertaining to deaf and hard-of-hearing people and effective practice;
5. Basic audiology (type and degree of hearing loss, technology, information on cochlear implants, and implications);
6. Significant issues in etiology, onset, and the discovery that one is deaf or hard of hearing;
7. Visual and telecommunication technologies (mobile phones with text and video communication features and video relay services, and alerting devices;
8. Sociocultural realities, social constructions, and multicultural awareness and values for a diverse deaf and hard-of-hearing community;
9. Strengths and resources of deaf and hard-of-hearing individuals, families, groups, communities, and organizations;
10. Effective engagement skills such as use of eye contact and spatial orientation with deaf and hard-of-hearing people, their families, communities, and organizations;
11. Unique social justice issues, including experiences with oppression, discrimination, and institutional audism;
12. Legislation and civil rights such as The Rehabilitation Act (1973), the Americans with Disabilities Act, and the Individuals with Disabilities Education Act (2004); and Newborn Infant Hearing Screening and Intervention Act of 1999.
13. Psychosocial dynamics of families with deaf members;
14. Awareness of community and professional resources; and
15. Knowledge of the code of ethics of professional sign language interpreters and their appropriate roles
Current literature explores psychotherapeutic issues inherent in working with diverse groups of deaf and hard-of-hearing people (Glickman & Harvey, 1996; Leigh, 2010). The range, purpose, and settings of social work practice with deaf and hard-of-hearing people are the same as they are for anyone else. Exceptions exist in that some services may be provided in organizations and educational programs specifically designed and established by or for deaf and hard-of-hearing people.
Deaf and hard-of-hearing people may have connections to a variety of professionals throughout their life course, which may exceed the professional connections of hearing people (Harvey, 2003). These professionals may include deaf education teachers, school psychologists, school social workers, audiologists, sign language interpreters, and speech therapists, who may be tied to a child or adolescent’s individualized education plan mandated by the Individuals with Disabilities Education Act. Sign language instructors, vocational rehabilitation specialists, telecommunications specialists, and specialized community service providers working with organizations serving deaf and hard-of-hearing people may be additional professional resources available.
Legislation Impacting Services for Infants, Children, and Adults
Social workers must be cognizant of the provisions of salient federal laws protecting the human rights of people with disabilities including people who are deaf and hard of hearing. The passage of the Americans with Disabilities Act had significant impact on the provision of social services to deaf and hard of hearing people since its implementation in 1990. The Twenty First Century Communications and Video Accessibility Act of 2010 strengthens telecommunications access and allows people who are deaf and blind to purchase services and equipment needed for communication. The Federal Newborn Infant Hearing Screening and Intervention Act of 1999 has allowed for early testing and identification of deaf and hard-of-hearing infants and opportunities for early intervention, including language and communication, and the facilitation of early parent child attachment. To meet the demand of trained professionals who have the knowledge and skill to work with newly identified deaf infants, Gallaudet University has established a certificate program with this specialty (Gallaudet University Graduate Catalog, 2012–2013). Deaf and hard-of-hearing youth today have a broader range of postsecondary education options than ever before; a greater number of deaf and hard-of-hearing people are attending college, and deaf people are entering a greater number of professional fields than ever before. However, data show that large numbers of deaf high school students are below grade level in academic achievement (Qi & Mitchell, 2012) and do not receive a high school diploma (National Center for Education Statistics, 2006).
School composition and placement of deaf and hard-of-hearing youth have changed drastically over the past 30 years. Today, most deaf and hard-of-hearing children receive at least some of their instruction in the regular classroom with hearing children (Mitchell & Karchmer, 2006, 2011). This has created challenges for the social and emotional well-being of deaf and hard-of-hearing children who are without a reference group in the mainstream, and whose school personnel may not be prepared to understand or meet their educational or communication needs in the classroom.
School social workers can play an important role in a deaf or hard-of-hearing child’s educational programming. Yet, only 6.4% of schools serving deaf children had school social work services in 2010 (Gallaudet Research Institute, 2011). The Masters of Social Work Program at Gallaudet University offers a sub-concentration in school social work to fill this void. The Individuals with Disabilities Education Act (IDEA) requires that elementary and secondary schools design an individualized education plan for deaf and hard-of-hearing students to meet the child’s unique educational and communication needs. Educational needs of each child are determined case by case and may include assistive technologies or sign language interpreters and related services such as counseling, social work, and psychological services.
On a community level, in a post–September 11 world, it is imperative that deaf and hard-of-hearing people and their communities are involved in emergency preparedness plans in their communities (Sheridan, 2008; White, 2006).
Consumer and Self-Advocacy
The Deaf community takes great pride in the effectiveness of its self-governed advocacy and community service programs. These organizations may provide case management and mental health services, systems advocacy, telecommunications devices and services, sign language interpreting, various prevention and intervention services (substance abuse, HIV and AIDS, domestic violence), sign language instruction, education in independent living skills, social and recreation programs for deaf and hard-of-hearing youth, technical assistance and consultation, and parent mentoring. Social workers working with deaf and hard-of-hearing people should consider these organizations as a rich source of collaboration.
Social work practice with this population involves several ethical considerations, including the recognition of the practice competencies necessary to effective work with deaf and hard-of-hearing people and the adoption of an empowering approach to practice. The social work principle of self-determination is of primary importance when working with deaf and hard-of-hearing people and their communities. The cohesive interdependent nature of the Deaf community demands strict adherence to confidentiality and boundaries. The social worker should avoid dual roles where additional professional, volunteer, or social activities in the deaf or hard-of-hearing community interfere with those of their consumers.
Social workers should be mindful of their own medical or cultural perspectives of deaf and hard-of-hearing people, allowing individuals and families to make informed decisions about controversial issues such as educational placement, communication approaches (an emphasis on oral and aural approaches to communication or visual methods, including ASL), and cochlear implants.
Most disability groups advocate that integrated educational programming through architectural and mobility access is the least restrictive environment for children with disabilities (Barnartt, 2007). However, because education depends on effective communication in the classroom and social environment of the school, mainstreaming can actually be the most restrictive choice for many deaf and hard-of-hearing children (Barnartt, 2007; Oliva, 2004; Sheridan, 2008). Parents need the opportunity to fully explore the implications of integrated and segregated educational approaches in the context of their individual child’s needs.
Gutman (2002) and Leigh & Gutman (2010) discuss ethical issues in mental health practice with deaf and hard-of-hearing consumers. Competing interests and values of the deaf community and the medical model construction of a larger hearing society continue to exist. More people than ever in the United States use ASL. However, at a time when cochlear implants, molecular genetics, and other medical advances, continue to strive for a “cure,” the deaf community continues to face an uphill battle to gain control over their “bodies” and “voices” (Bauman & Murray, 2010; Padden & Humphries, 2005). This debate will continue and social workers will need to be sensitive to the competing social pressures and ethical dilemmas that they present for deaf and hard-of-hearing people and their families and their impact on diverse perspectives of self and identity (Leigh, 2009).
Cochlear implants, the subject of a bioethics debate between the medical profession and the deaf community, exemplify the conflict in medical and cultural perspectives of deaf people (Blankmeyer-Burke, 2012). Concern for nonmalfeasance, community survival, autonomy, principles of justice, and individual rights are at the center of this debate (Christensen & Leigh, 2002; Paludneviciene & Leigh, 2011). Properly informed social workers can assist their consumers in making informed decisions about current technologies, such as cochlear implantation and genetic testing, and will need to keep abreast of other technologies on the horizon.
Current Trends, Challenges, and Future Directions
The lives of deaf and hard-of-hearing people have changed rapidly over the past few decades with educational and social reforms, legislation, technological advances, and scientific progression (Sheridan, 2008). As a result, the deaf community is becoming increasingly diversified and the community is faced with new challenges of self–definition, individual and collective expression, and cultural and linguistic survival (Humphries, 2008).
Deaf and hard-of-hearing people have access to television and media and take advantage of the ever-changing technology in the 21st century. Today’s deaf youth are the first generation of deaf people to grow up with closed-captioned television and occasional captioning in movie theatres and at educational events. In addition, the Internet has made information readily available to deaf and hard-of-hearing people. Although English-language limitations have disadvantaged some in this process, increasingly available person-to-person videophones, video relay services, video remote interpreting, and “vlogs” are paving the way for greater access to communication technology. Telecommunication relay services, reliance on digital pagers, e-mail, instant messaging, and video telecommunications have revolutionized communications for deaf and hard-of-hearing people and helped to level the playing field accessing educational opportunities, jobs, and leisure. In spite of the new technology that is helping to level the playing field for deaf people, the glass ceiling still exists in educational and employment opportunities in all fields, including the health care professions (Rashid, 2012; Task Force on Health Care Careers for the Deaf and Hard-of-Hearing Community, 2012). Social workers should be mindful of the potential benefits of technology and advocate for resources that may close the gaps that prevent economically disadvantaged deaf and hard-of-hearing people from accessing them.
Role and Implications for Social Work
Culturally competent social workers who are fluent in the national sign language of their clients are needed around the world to provide a wide range of services to deaf and hard-of-hearing people, their families, communities, and organizations. Social workers should understand the psychosocial and communication needs of those who are hard of hearing, elderly, deaf–blind, and have additional disabilities. Even with technical advances to reduce communication barriers between deaf and hearing people, deaf and hard-of-hearing people most often prefer face-to-face interactions with competent social workers who can effectively communicate with them. In some court cases, judges have ruled in favor of direct communication without the use of interpreters (Tugg v. Towey, 1994). Social workers should adopt an empowering approach to practice with this population.
Career opportunities exist for social workers with the necessary competencies to work with deaf and hard-of-hearing people in any of the earlier-mentioned settings in addition to medical, social, mental health, and other service arenas. Gallaudet University in Washington, D.C. offers undergraduate and graduate social work education with an advanced MSW concentration in deaf and hard of hearing populations. This cadre of professionals with the cultural and linguistic competence to work with this population adds to the rich cultural diversity of our profession.
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