Models of deafness; Counseling


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Models of deafness; Counseling

  1. 1. Models of deafness<br />Objectives: <br /><ul><li>Discriminate medical and social models of deafness.
  2. 2. Recognize related biases in self and others.</li></li></ul><li>Deaf history<br />Repression<br />Inclusion<br />Accommodation<br />Segregation<br />
  3. 3. Deaf history<br />1500-1600s Beginning of formal deaf education<br />1880 Milan Congress on Deaf Education<br />Oral education preferred to sign education<br />Homogenized deaf people<br />1964 Babbidge Report<br />Oral education method is failing deaf students<br />1988 Deaf President Now<br />Board of Gallaudet University appointed a hearing person as its 7th president<br />Students protest until president resigns<br />1990 IDEA passes<br />Deaf schools considered “Most Restrictive Environment”<br />
  4. 4. Technological Revolution<br />TTYs<br />Closed Captioning<br />Mobile Text<br />Instant Messaging/ Skype<br />Video Relay Service<br />Assistive Devices<br />Hearing Aids<br />OAE/ABR<br />Newborn Hearing Screening<br />Cochlear Implants<br />
  5. 5. Medical model<br />Deafness as pathology<br />Deafness as treatable<br />Deafness as curable<br />
  6. 6. Sociocultural model<br />Deafness as identity<br />Deafness as special<br />Deafness as linguistic / cultural minority<br />
  7. 7. World Health Organization International Classification of Functioning (ICF)<br />Functioning is an outcome of interactions between health conditions and contextual factors<br />Health conditions<br />Disease, disorders, injuries<br />Contextual factors<br />External: environment, social structures, terrain, etc.<br />Internal: personality, age, SES, education, etc.<br />
  8. 8. Functioning and Deafness<br />Health Conditions<br />Medical<br />Contextual Factors<br />Social<br />
  9. 9. Deaf Epistemology<br />Audism<br />Body is starting point for social classification<br />Deaf bodies are broken<br />Muteness = less intelligent<br />Education and occupational systems not structured to accommodate hearing loss<br />Visually-oriented<br />Hauser 2010<br />
  10. 10. Silent news cartoon (~1994)<br />
  11. 11. Press release 4/27/09<br />Cochlear Americas Launches New Rehabilitation Program for Cochlear Implant Recipients<br />About Cochlear AmericasCochlear Americas is the world's leader in advanced hearing technologies.  Since launching the first multichannel cochlear implant system more than 25 years ago, Cochlear Limited and its U.S. headquarters have brought the miracle of sound to more than 150,000 hearing-impaired individuals across the globe.  Cochlear Americas’ state-of-the-art cochlear implant technology, based on extensive research and development at preeminent academic institutions, provides the ability to hear sound and better understand speech, enhancing both learning capabilities and quality of life for those with severe-to-profound hearing loss.<br />
  12. 12. How does Communication Disorders and Sciences fit into this discussion?<br />
  13. 13. Counseling<br />Objectives: <br />Contrast informational and adjustment counseling.<br />Identify response types useful in counseling.<br />
  14. 14. Informational counseling<br />Also called content counseling<br />Description of hearing loss<br />Explanation of intervention choices<br />Typically doesn’t address emotional affect of hearing loss<br />Typically one-way, practitioner to client<br />
  15. 15. Adjustment counseling<br />Provide a comfortable climate where positive and negative feelings can be expressed without penalty<br />Encourage client to verbalize how he/she feels others perceive him/her<br />Explore nature of interpersonal relations and how having a hearing loss affects them<br />Help client discuss, analyze and evaluate feelings<br />Sanders 1982<br />
  16. 16. Adjustment counseling<br />Facilitate definition of situations/ events that arouse those feelings<br />Help client explore various ways of dealing with feelings and evaluate effectiveness of those ways<br />Encourage client to express feelings about self, the handicap, frustrations and aspirations<br />Sanders 1982<br />
  17. 17. Closed versus open questions<br />Closed questions<br />Can be answered with a single word.<br />Stifle expression.<br />Can seem directive.<br />Open questions<br />Can be answered broadly.<br />Encourage expression.<br />Lead to further awareness.<br />
  18. 18. Closed versus open questions<br />Are you sad?<br />How are you feeling?<br />When do you have that experience?<br />Do you like your teacher?<br />What are the advantages of doing it that way?<br />Does your mother agree?<br />Are you going to stop talking to that boy who’s been teasing you?<br />
  19. 19.
  20. 20. Parent concerns<br />My child is deaf. She’ll never hear anything.<br />Focuses on negative, what’s missing. Switch focus to positive, what’s available.<br />Will the hearing aid/cochlear implant correct/cure the hearing problem?<br />Derives from hope that child can become “normal”.<br />The intervention can enhance hearing, but, unlike glasses, will not allow her to hear as though there were no impairment.<br />Will my child learn to talk?<br />Will my child be able to go to school?<br />Sanders 1982<br />
  21. 21. Responding to parents<br />What they say vs. what they mean.<br />“I know you’ll be mad, but Ashley hasn’t been wearing her hearing aids the past 2 weeks”<br />How do you respond?<br />
  22. 22. Types of responses<br />Honest<br />Hostile<br />Judging<br />Reassuring<br />Reflective<br />Silent<br />Nonverbal<br />Clark & English 2004<br />
  23. 23. Honest response<br />Give full answers with no “silver linings”<br />Give realistic answers<br />Do not prognosticate with insufficient supporting data<br />
  24. 24. Hostile response<br />Typically a response to a perceived affront of the professional’s knowledge or training<br />Never become hostile with a hostile patient<br />Show that you respect and understand their frustration<br />
  25. 25. Judging response<br />Passing judgment on patient’s actions<br />Projecting onto patient’s how we believe they should act<br />Should allow patients to talk out their feelings and attitudes<br />
  26. 26. Reassuring response<br />Can stifle patient’s ability to express how they are feeling.<br />How would you feel if someone told you, “It’s not as bad as it seems” or “Lots of people have it worse than you”<br />
  27. 27. Reflective response<br />Reflection is the attempt to understand the patient’s viewpoint and communicate that understanding in a way that permits the patient to examine their feelings from another perspective.<br />Develop an understanding through reflection of the patient’s feelings.<br />“You don’t feel your child is hearing significantly better in many environments?”<br />“You are angry that your teacher doesn’t see how hard you are trying?”<br />
  28. 28. Silent response<br />Silence can provide temporal space for reflection and an opportunity for patients to assume responsibility for their own progress.<br />Gives patients permission to take time for struggling with emotions.<br />
  29. 29. Nonverbal response<br />Includes tone of voice, posture, eye contact, gesture.<br />Good nonverbal responses include<br />Eye-level communication<br />Good eye contact<br />Leaning forward<br />Purposeful head-nodding<br />
  30. 30.
  31. 31. Child concerns<br />Kids won’t play with me because I don’t hear everything they say<br />I’m afraid to tell other kids I wear hearing aids<br />I’m afraid to talk in class in case I didn’t understand<br />I’m afraid to talk to the cute boy who my friend says likes me<br />
  32. 32. Child concerns<br />I’m afraid to try out for an activity because my hearing/speech isn’t good enough<br />I’ve stopped wearing my hearing aid because I’m embarrassed<br />The teacher won’t call on me because my speech embarrasses everyone<br />
  33. 33. Child concerns<br />Hearing loss will<br />jeopardize relationships with peers<br />limit developing relationships with potential dating partners<br />affect acceptance by teachers<br />limit academic achievement<br />
  34. 34. Do not minimize the concerns!<br />Accept the child’s statement<br />It’s true for them<br />Explore the feelings<br />Consider situation where feeling arises<br />Investigate ways of dealing<br />If you did X, what’s the worst thing that could happen?<br />
  35. 35. Counseling checklist<br /><ul><li>Help children tell their story
  36. 36. Help them clarify their problem
  37. 37. Help them challenge themselves to solve the problem
  38. 38. Help them set a goal
  39. 39. Help them develop an ‘action plan’
  40. 40. Observe as they implement the plan
  41. 41. Help them evaluate the plan</li></ul>From English, K. (2002) Counseling Children with Hearing Impairment and Their Families.<br />
  42. 42. It is better to say<br />“What do you think is the best thing for you to do next?”<br />than<br />“What you should do next is…”<br />
  43. 43.
  44. 44. I Start, You Finish<br />Open-ended activity to understand child’s self-awareness and self-perception<br />Do not sit face-to-face, but side-by-side or at right angles<br />“I have some sentences here that have no endings. I was wondering how you would complete them. I’ll start them off and ask you to finish them for me. You can add more sentences to each one if you want. We can take our time and talk about your sentences for as long as you want.”<br />
  45. 45. I Start, You Finish<br /><ul><li>I am happy when…
  46. 46. I am sad when…
  47. 47. The thing I like most in the world is…
  48. 48. The thing I would most like to change is…
  49. 49. Because I have a hearing problem…
  50. 50. I’m afraid to…
  51. 51. I wish…
  52. 52. One thing I do very well is…
  53. 53. One thing I like about myself is…</li></li></ul><li>I Start, You Finish<br />“Thank you for teaching us what it’s like for you. Is there any help you need from me?”<br />Open-ended<br />Child can explore anything he/she chooses<br />If child seems uncomfortable, end the activity.<br />
  54. 54. Dreams and Maps<br />Encourage child’s responsibility and ownership of hearing loss by developing goals.<br />Each goal and each child involves unique steps, they need to be considered and discussed one at a time.<br />Child may see how use of communication strategies and amplification fit into goals.<br />
  55. 55. Dreams and Maps<br />
  56. 56. Dreams and Maps<br />
  57. 57. Dreams and Maps<br />May need to reassess steps to goal to see if they are working.<br />Can use SMART goal technique to help child formulate their plan.<br />
  58. 58. When to refer<br />If the situation is beyond your scope of practice<br />marital, familial, financial stress <br />emotional fragility<br />If you don’t feel comfortable<br />Have referral information readily available<br />