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.

Working therapeutically with deaf people recovering from trauma and addiction.

OBJECTIVE: This article reviews what is known about behavioral health treatment of deaf persons with comorbid trauma and addiction. METHOD: We discuss how to work therapeutically with deaf people with comorbid trauma and addiction, both through a review of the literature and through clinical observations of the authors. The article also includes the personal stories of two people-a Deaf peer specialist and a hearing psychiatrist-who share their humbling stories about the recovery process for deaf people and the challenges of learning to become an effective Deaf mental health care provider. FINDINGS: Deaf people report higher rates of mental health problems than the general population. Although initial empirical work with the deaf population suggests high rates of posttraumatic stress disorder (PTSD) and substance use disorder (SUD), little is known about the rates of comorbid PTSD/SUD or how to effectively address this comorbidity in treatment. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Substantial work is needed to raise awareness of comorbid PTSD/SUD and provide treatment tools to agencies and providers who work with deaf clients, infusing trauma-informed care into deaf SUD services and SUD treatment into deaf mental health care. Fortunately, several endeavors are on the horizon to disseminate assessment and treatment tools to work with deaf people recovering from trauma and addiction.

Demographics, psychiatric diagnoses, and other characteristics of North American Deaf and hard-of-hearing inpatients.

This study examined demographic and clinical data from a specialty deaf inpatient unit so as to better understand characteristics of severely and chronically mentally ill deaf people. The study compares deaf and hearing psychiatric inpatients on demographic variables, psychiatric discharge diagnoses, a language assessment measure, a cognitive ability measure, and a measure of psychosocial functioning and risk of harm to self and others. Overall, findings indicate a broader range of diagnoses than in past studies with posttraumatic stress disorder being the most common diagnosis. Compared with hearing patients in the same hospital, deaf patients were less likely to be diagnosed with a psychotic or substance abuse disorder and more likely to be diagnosed with a mood, anxiety, personality, or developmental disorder. Psychosocial functioning of the deaf patients was generally similar to hearing psychiatric patients. Deaf patients presented significantly higher risks than hearing patients in areas of self-harm and risk of sexual offending. Cognitive scores show that both the deaf and hearing inpatient population is skewed toward persons who are lower functioning. An additional surprising finding was that 75% of deaf individuals fell into the nonfluent range of communication in American Sign Language.