Disabilities
Meeting the Needs of Deaf and Hard of Hearing Clients By Ariel Meltzer, MSW, LSW
“Knowing there are a growing number of D/d/ HH individuals in our great state of New Jersey, we as social workers need to be mindful of the clinical considerations when working with and/or referring D/d/HH clients for their therapeutic needs.”
I
can recall in 2019, chatting with a colleague I had met about our respective journeys toward becoming social workers, while attending a New Jersey Division of the Deaf and Hard of Hearing (NJ DDHH) board meeting. As a Hard of Hearing (HH) adult and newly licensed social worker, I embarrassingly chuckled with my colleague about how difficult the LSW exam was for me, given that I grew up using both English and American Sign Language (ASL); I ran into multiple language barrier issues before finally passing it. My colleague, who identifies as Deaf, nodded in agreement, stating that he has taken the exam a few times and continues to struggle with passing due to ASL being his first language. He went on to explain his concern around a general lack of D/d/HH (Deaf/deaf/Hard of Hearing) social workers practicing in NJ, which he believes is due in part to the language barrier and passing the LSW exam. Today, as a practicing mental health clinician, I look around me and realize my colleague is right. I can count on my fingers the number of licensed social workers in NJ who are fluent in ASL, let alone identify as D/d/HH. This has led me to reflect on a number of barriers that D/d/HH clients may face in New Jersey, as well as clinical considerations for social workers when working with D/d/HH clients.
NJFOCUS •Spring 2024
First, let ’s look briefly at NJ D/d/HH statistics as well as D/HH culture and community terms. According to the most recent data published by the Center for Disease Control and Prevention (CDC), in 2020, there were 98 babies born in New Jersey who were diagnosed with permanent hearing loss. 1 In 2018, The New Jersey Department of Human Services announced to the public that approximately “850,000 New Jersey residents have varying degrees of hearing loss ranging from mild to profound. This includes individuals who are born deaf and people who encounter late-stage hearing loss.” 2 When we think about D/d/HH individuals, like other minorities, we can think of a spectrum of varying degrees and ranges of hearing loss, as well as an identity that D/d/HH individuals may assign themselves. A capital “D” represents individuals who identify within Deaf culture, whereas a lowercase “d” represents individuals who may not identify within Deaf culture, and/or outside of the culture. For example, an individual who lost their hearing later in life may not identify with Deaf culture, and instead, may think of their hearing loss as just that—a hearing loss, without any attachment and/or identification to Deaf culture. On the topic of Deaf culture, this community represents individuals who may be Deaf, deaf, HH, CODA (Child of Deaf Adult), and/or an ASL interpreter.
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A lack of mental health providers who identify as D/d/HH. This is due in part to the following challenges: •
Struggling to pass the LSW and/or LCSW exam due to language barriers;
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Fear of test-taking; and,
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Lack of D/d/HH ADA accommodations for taking the exam.
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A lack of mental health providers who are fluent in ASL.
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A lack of inpatient and outpatient mental health services with knowledge and/or experience of and working with the D/d/HH community, including understanding language, community, culture, and sensitivity.
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Being a minority, D/d/HH communities tend to be small, and mental health providers who are qualified to work with D/d/HH clients need to consider the ethical implications (i.e., dual relationships).
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A lack of D/d/HH and/or ASL-fluent mental health providers who specialize in a specific area of mental health that the D/d/HH client is seeking.
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A lack of qualified, RID-certified (Registry of Interpreters for the Deaf ) ASL interpreters, should the client request an interpreter when working with a non-ASL mental health provider.
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Access to healthcare issues: •
It can be challenging for D/d/HH individuals to gain employment, and as such, there are D/d/HH clients who do not have insurance and will not be able to make payment towards mental health providers;
NJFOCUS • Spring 2024
Disabilities
Reflecting on discussions with clients and colleagues who identify as D/d/HH and those who, while not D/d/HH identifying, work and collaborate in a space with D/d/HH individuals, let's look at some barriers that D/d/HH individuals may face:
Disabilities
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A D/d/HH individual may not qualify for sliding scale, or there is a general sliding scale unavailability at the practice at that time; and, Many practices do not accept Medicare or Medicaid
Knowing there are a growing number of D/d/HH individuals in our great state of New Jersey, we as social workers need to be mindful of the clinical considerations when working with and/or referring D/d/HH clients for their therapeutic needs. These include: • •
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Language choice of the client (i.e., ASL? Spoken English? Both?); Preference of therapist in terms of D/HH identifying or not (i.e., D/d/HH therapist? Hearing therapist?); Cultural implications (if any) of the client's D/d/HH identification; Intake assessments may need to be modified if, for example, ASL is used as a first language for the client;
clinical challenges these clients face and put them into action through collaboration and dedication. For more information on assisting NJ D/d/HH clients in the following areas including, but not limited to: •
How to hire an ASL interpreter;
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Deaf and Hard of Hearing Sensitivity Training;
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ASL learning resources;
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Equipment distribution;
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Employment;
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Emergency Preparedness;
please visit: https://www.nj.gov/humanservices/ddhh/
References: 1
https://www.cdc.gov/ncbddd/hearingloss/2020-data/07-diagnosed-by-3-months.html
2
https://www.state.nj.us/humanservices/news/press/2018/approved/20180518.
html#:~:text=About%20850%2C000%20New%20Jersey%20residents,encounter%20 late%2Dstage%20hearing%20loss
For telehealth clients: •
Adjusting the screen to show full view of hands if the client is using ASL;
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Stable internet connection to avoid choppy/slow connection for effective ASL and/or lip reading communications;
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Offering a telehealth platform that has captions and is HIPAA-compliant (e.g., Zoom; Google Meet subject to certain conditions being met); and,
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For non-ASL fluent mental health providers, ensuring the client who requires ASL has access to an ASL interpreter.
As social workers in NJ, together, we can make therapy more accessible for D/d/HH clients by continuing to be mindful of the barriers and
NJFOCUS •Spring 2024
About the Author: Ariel Meltzer, MSW, LSW identif ies as a HH adult, and is a mental health clinician and Certif ied Trauma Professional (CTP) with The Princeton Center for MindBody Healing. Ariel is fluent in ASL and provides mental health therapy for both D/d/HH identifying and hearing clients. She works with young adults, adults, and elder populations.
