2020-06-17 Identifying Barriers and Resources DHOH SUD

Identifying Barriers and Resources When Working with Deaf and Hard of Hearing People with Substance Use Disorders

6/17/2020

Presented by Deb Guthmann, EdD, NIC 1

I D E N T I F Y I N G B A R R I E R S A N D R E S O U R C E S

W h e n W o r k i n g w i t h D e a f a n d H a r d o f H e a r i n g P e o p l e w i t h S u b s t a n c e U s e D i s o r d e r s

Welcome, your facilitator will be: Samson Teklemariam, LPC, CPTM• Director of Training and Professional

Development for NAADAC

• NAADAC, the Association for Addiction Professionals

• www.naadac.org

• [email protected]

www.naadac.org/webinars

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www.naadac.org/identifying-barriers-resources-DHH-webinar

Cost to Watch:Free

CE Hours Available:1 CE

CE Certificate for NAADAC Members:Free

CE Certificate for Non-members:$15

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Using GoToWebinar(Live Participants Only)

Control Panel

Asking Questions

Handouts

Audio (phone preferred)

Polling Questions

Deb Guthmann, Ed.D., NIC• National Consultant: Substance Use

Disorder, Mental Health, Ethical Considerations when working with Individuals who are Deaf or Hard of Hearing

• www.mncddeaf.org

• [email protected]

NAADAC Webinar Presenter

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Webinar Learning Objectives

Participants will be able to identify barriers and resources related to assessment, treatment and aftercare services for Deaf and Hard of Hearing(DHH) individuals.

Participants will be able to identify treatment components used in specialized programs for DHH individuals.

Participants will be able to identify resources and screeners available online in American Sign Language (ASL) that can be used with DHH clients.

Polling Question 1

How many trainings focused on working with Deaf and Hard of Hearing individuals have you previously attended?

A. 1-2

B. 3-4

C. 5+

D. I have never attended a training on this topic before

No Deaf, DeafBlind or Hard of Hearing Person is Alike in

Their ability to hear

Their ability to speak

Their ability to use English

Their ability to communicate and understand

Their functional skills

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Terminology Do’s and Don'ts10

DO SAY: Don’t Say:

Deaf Deaf and Dumb

Hard of Hearing

Deaf-Mute

Late Deafened

DeafBlind Hearing Impaired

Health Literacy and the Deaf Community Compromised English literacy, limited access to sign language interpreters in healthcare settings,

the lack of exposure to health information (e.g., via radio, TV, overheard conversations, published media, public service announcements and families who may not know ASL) can limit health literacy for Deaf individuals.

Adding captions (English subtitles) to audiovisual media (recordings, radio programs, podcasts, television programs, movies, DVDs, videotapes, etc.) or providing a written English transcript does not meet the needs of all Deaf people whose first language is American Sign Language(ASL) and not English.

For the above stated reasons, members of the Deaf community may miss the opportunity to engage with health providers. This can be a contributing factor to increased hospitalizations due to preventable ailments, a rise in unmanaged chronic conditions and a decrease in routine healthcare screenings, preventative services and treatment.

Pollard, R. Q. & Barnett, S. (2009). Health-related vocabulary knowledge among deaf adults. Rehabilitation Psychology, 54(2), 182-185.

Position Statement On Health Care Access For Deaf Patients, NAD https://www.nad.org/about-us/position-statements/position-statement-on-health-care-access-for-deaf-patients/

Needs and Services Based on the overall national population of Deaf individuals.

Based on the general estimates of at least one out of 10 hearing people needing treatment.

Estimates would indicate that thousands of Deaf people may need treatment, and we aren’t seeing them in programs.

There are very few specialized treatment programs designed to meet the needs of D/HH individuals.

Many people can only access services designed for hearing people.

Lack of knowledge about alcohol and other drugs and available resources(leave college, lack of support)

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Risk Factors within the DHH Community1. There may be communication problems within the family (90% of Deaf children born to hearing parents)

a. Incidental learning does not happen as frequently for DHH individuals(dinner table)

2. Lack of comprehensive education/prevention programs in schoolsa. Lack of appropriate curriculumb. Pressure to focus on academicsc. Information from media is not accessible

3. Difficulty with peer relationships (drug dealers-Associated Press)4. Enabling

a. Treatment vs. jailb. Rescue attempts soften consequences (signs and symptoms overlooked, fail to confront)c. Not always held accountable for behavior (stopped by police, students & ecstasy, ATM)

5. Lack of knowledge and support in the Deaf communitya. Deaf clubs, sports & other activities involving alcohol, etc.

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Treatment Barriers in the Deaf Community Lack of accessible, culturally appropriate, evidence-based programs

Shortage of professionals(need to build & sustain a qualified workforce)

Lack of materials

Lack of appropriate assessments(English based)

Funding issues(low incidence population)

Drug and alcohol use is strongly stigmatized(negative if not drink).Deaf community is smallDeaf “grapevine”, confidentialityLack of D/HH in recovery

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How Language and Deaf Community Impact Aftercare

1. Inaccessible aftercare hampers success in sobriety.2. Stigma in Deaf community creates shame-based thinking, causing isolation and self doubt.3. Concerns about confidentiality .4. Fewer accessible meetings means smaller network of peers in recovery.5. Avoiding old places or old people not always feasible. 6. Some communities still have antiquated ideas about recovery / addiction / lack of

knowledge.

Ex. “AA” as sign for alcoholic.Hard for families to access Al-Anon or other supports.Some members of closed meetings don’t want an interpreter there because they are not in recovery.

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Factors that help Recovery

Accessible 12-Step Meetings (interpreted, ASL, Zoom)

Friends and family support

Employment or school attendance

Living in sober housing

Having a sponsor

Participating in Aftercare

Adapting the Assessment and Treatment Process When

Working With Interpreters

Information to Share With Interpreters Prior to the Assignment

When Scheduling

Make sure to only use Certified Sign Language InterpretersCertified Interpreters are covered under HIPAA as Business AssociatesClarify the type of assignmentAllow extra time when an interpreter is present

Pre-Session Day of Appointment

Overview of what will be coveredCopies of any paperwork (prior to the appointment if possible)Plan if there is a communication breakdownAny specialized vocabulary or acronyms you may use

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Working with InterpretersProvider Tips

Hold a pre-session to orient the interpreter to the goals of the session and special techniques you may use.Work with the interpreter and the client to determine the best possible physical placement for all parties in the situation.Face the client and address questions and comments to them not to the interpreter.Use first person language; avoid saying, “Ask him...” or “Tell her...”Know that the interpreter can only provide information about the client’s language, not personal information or opinions about the client.Be prepared to expand the meaning of specific vocabulary and concepts.Use tools such as calendars, pictures, etc. to help with concept explanation.

Interpreter ConsiderationsExpect that the interpreter may occasionally pause to ask you for an explanation or clarification of terms in order to provide an accurate interpretation.

Recognize that the interpreter will interpret everything that is said in the presence of all individuals and will not edit out anything spoken as an aside or anything that is said to others in the room. (Full transparency)

Be aware that the interpreter is responsible only to interpret and is never responsible to supervise the client.

Hold a post-session with the interpreter to sort out communication issues and possible therapeutic concerns such as transference/counter-transference that may have surfaced.

Video Relay Services & Video Phones 20

Video Remote Interpreting21

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Video Relay Services & Video Remote Interpreting

Video Relay Services (VRS) Video Remote Interpreting (VRI)

Requires high-speed internet and a computer with a webcam and is intended to provide equivalence for telephone communication to deaf and hard-of-hearing people.

Requires high-speed internet and a computer with a webcam.

Publicly funded and used for a variety of purposes i.e. making appointments, ordering pizza, talking with a friend, banking.

More likely to be used in critical situations such as medical care, courts and first responders.

Due to FCC requirements, VRS is limited to communication between individuals in two different locations, and at least one of the individuals must be deaf or hard of hearing.

Enables two people, who speak different languages, in the same location (for example, a doctor and a patient) to communicate by using the services of a remote interpreter.

Only the interpreter and the deaf person see each other. The person using spoken language hears the interpreter’s voice but does not see that person or the deaf person. Essentially, the hearing person is simply talking on the telephone

All parties can see each other – for example, both patient and doctor are able to see the remote interpreter- concerns in some situations such as when doctors do physical examinations.

Considerations When Using Technology

Pros / Potential

Cost Effective

Stretch limited resources like Deaf or ASL-fluent staff or interpreters

Reduces travel and No-Show rate

Allows for Deaf-only groups in a variety of geographical locations

Visual assessment possible

Gives Deaf people more options

Cons / ChallengesTechnology sometimes fails i.e. camera freezes, internet speed too slow

You can’t hug a webcam

Limitation of providing counseling outside state boundaries

Video Remote Interpreters (VRI) may not know individual’s language needs

Will not meet everyone’s needs

Crisis Plans must be in place

Role of Interpreter and VRI

Role of Interpreter

https://youtu.be/hzOP7Ee-x7Q

VRI: A Fathers Storyhttps://www.youtube.com/watch?v=X7_FhNFriq0

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Polling Question 225

What barriers have you seen most often in your work?

A. Knowing how best to work with sign language interpreters

B. Cost of sign language interpreters

C. Lack of accessible materials for assessment and treatment

D. Aftercare options

Research and Prevalence Information

Substance Use in the Deaf and Hard of Hearing Population

There are no well-controlled, methodologically sound community estimates of drug/alcohol use among D/HH people.

We do have estimates of use and other studies that are based on deduction or from small, restricted, or non-representative samples.

Example: One year follow up study of 100 Deaf and Hard of Hearing Individuals who completed treatment at the Minnesota Program and what contributed to their abilityto maintain sobriety:

1. Attendance at self-help recovery meetings. 2. Having family members and friends to talk to about their sobriety. 3. Employment.

Guthmann, D. & Blozis, S. (2001). Unique Issues Faced by Deaf Individuals Entering Substance Abuse Treatment and

Following Discharge. The American Annals of the Deaf. Volume 146(3), pp. 294-303.

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Minnesota Substance Use Disorder Program for Deaf and Hard of Hearing Individuals

One of the first (and longest running) model inpatient treatment programs in the United States for Deaf and Hard of Hearing Individuals.

Opened on March 14, 1989 initially as a Specialized Adolescent Treatment Program and since 1990, primarily serves deaf and hard of hearing adults;

Received several Minnesota State Grants as well as federal grants through CSAT and RSA.

Total Number of inpatient clients served = 1668.

What do you think clients listed as their preferred drug of choice (based on datafrom the Minnesota SUD Program for Deaf and Hard of Hearing Individuals)?

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Minnesota Substance Use Disorder Program for Deaf and Hard of Hearing IndividualsPrimary Drug Use at Admission

March 14, 1989 – December 31, 2019N= 1668

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872

277207 192

98 60 48 1280

100200300400500600700800900

1000

18

83107

242249

271

152

6618

10

50

100

150

200

250

10 to 17 18 to 21 22 to 24 25 to 30 31 to 3536 to 43 44 to 50 51 to 6061 to 70 71 & up

AGE-MALESMarch 14, 1989 – December 31, 2019

Males = 1207N = 1668

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10797

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23 6 10

10

20

30

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50

60

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90

10 to 17 18 to 21 22 to 24 25 to 30 31 to 35 36 to 43 44 to 50 51 to 60 61 to 70 71 & up

AGE-FEMALESMinnesota Chemical Dependency Program

for Deaf and Hard of Hearing IndividualsMarch 14, 1989 – December 31, 2019

N= 1668Females = 461

Prevalence Studies in the DHH Population

Two years (2015 and 2016) of National Survey on Drug Use and Health (unweighted N=86,186) combined to compare substance use disorders among adults with and without self-reported hearing loss.

In 2016, participants were asked about sociodemographic characteristics, substance use, and for the first time, their disability status, including one hearing loss question:

Are you deaf or do you have serious difficulty hearing?

McKee, M., Meade, I., Zazove, P., Stewward, H., Jannausch, M., Llgen, M. (2018). The Relationship Between Hearing Loss and Substance Use Disorders Among Adults in the U.S. The American Journal of Preventative Medicine. 2018;000(000):1−5. Published by Elsevier Inc.

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Prevalence Studies in the DHH Population

18−34 years (N=46,048) 35−49 years (N=22,530) ≥50 years (N=17,608N= 722(1.5%)(with hearing loss)

N= 556(2.2%)(with hearing loss)

N= 1,697(9.4%) (with hearing loss)

33Characteristics of Adults Aged 18−34, 35−49, and ≥50 Years With and Without a Hearing Loss (Years 2015, 2016: Aged ≥18 Years)

Overall, hearing loss prevalence was 5.2%,

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Prevalence Studies in the DHH Population34

Hearing loss was associated with a greater likelihood of a prescription opioid use in the group aged 18−34 years and, for the group aged 35−49 years.

Hearing loss increased the likelihood of both an alcohol use disorder and a prescription opioid use disorder.

Adults with hearing loss aged 18−49 years are more likely to meet criteria for a SUD than their hearing peers;

No difference was found in SUD prevalence among adults aged 50 years and older.

Results

POINT 3..POINT 1.. POINT 2..

Prevalence Studies in the DHH Population35

In younger adults, the most consistent associations were seen between hearing loss and increased likelihood of prescription opioid use disorders; those with hearing loss were more than twice as likely to have a current opioid use disorder.

These findings are consistent with recent findings that individuals with hearing loss may abuse substances more frequently.

Results

POINT 4.. SUMMARY

Prevalence of use estimates in the Deaf Community

Is there a substance abuse problem in the Deaf Community and isit similar to the hearing population?

Clinical observation says - Yes, there is a substance abuse problemand it is probably just as serious – if not more so - than that among thehearing population.

QUESTION: Why do you think there is no scientifically rigorous prevalence data on Deaf and Hard of Hearing people?

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Assessment

Most assessments are not linguistically accessible as they are given in English, which may not be the Deaf individuals’ native language (Lack knowledge of culture and customs i.e. Deaf clubs, close-knit community, physical touching, etc.)

Lack of qualified interpreters and knowledge of terminology i.e. DUI, withdrawal, blackout.

Assessors may not have an interpreter available and may attempt to write back and forth in English which is not many Deaf individuals' native language.

Use of interpreters may hurt reliability.

Confidentiality issue, fear of community gossip

Culture clash – distrust of assessor and/or researchers, many of whom are hearing.

Factors in Assessment

How would you rephrase each question so that it would be understood by a Deaf client?

Have you ever had a D.U.I.?Have you ever had a blackout?Have you noticed an increase or decrease in tolerance?What is your longest period of sobriety?Do you consider yourself a binge drinker?Have you ever had a hangover?Have you ever passed out while drinking?Have you ever experienced withdrawal?

Assessment Terminology

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Here is an example of a written communication with a Deaf client about his drug use. It shows how writing can be an ineffective means of collecting information.

Using writing to assess!!!

Using Writing to do an Assessment or Intake(Actual example completed with a deaf client)

Question Response

What kind of drugs do you use? Pot

Do you use it everyday? Some Time

How much a day? I don’t know

How much money you spend a day on pot?

I can't remember how much money

Do you think you smoke 3 joints a day, 6 joints, maybe more?

3 joints a day

When was the last time you smoked? Today?

I don’t smoke today

Do you use any other drugs? Alcohol? Only pot and beer

Using Writing to do an Assessment or Intake(Actual example completed with a deaf client)

Question Response

How much beer you drink? Everyday? Only Weekends?

Both sometime not drinking for l or 3 days

When you drink beer, how many you drink in one day? 2? 4? More?

I only buy a case in one day

You mean you drink one case in one day? Not all beer, just till I got drinking and stop.

Do you have any medical problems? Do you have medication that a doctor gives you?

Yes, doctor give ma a pill and it make me sick

Do you know what kind of medicine? Called what?

It is hard to spell

When was the last time you smoked? Today?

I don’t smoke today

What was the medicine for? The doctor say it will help me calm down and not to be sad.

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NIDILRR Grant -Wright State University2014-2020 - National Institute of Disability, Independent Living and RehabilitationResearch, (NIDILRR) Disability and Rehabilitation Research Projects (DRRP).

Develop & validate a suite of web-based screeners and assessments foradministration and scoring in American Sign Language (ASL) that will reducebarriers for those working in education, vocational rehabilitation, mental health andsubstance use disorder settings.

1. Validation of 9 mental health and substance abuse screeners and assessments.2. Validation of The O*NET Short Form Interest Profiler(IP) (web-based 60-item).3. Training on the use of the online suite of tools.

Assessments/Screeners being translated and validated into ASL include:1. Alcohol Use Disorders Identification Test (AUDIT) (10 items)2. Drug Abuse Screening Test (DAST) (10 items),3. Beck Depression Inventory(BDI) (21items),4. Rosenberg Self-Esteem Scale (RSES) (10 items), 5. The Satisfaction with Life Scale (SWLS) (5 items),6. Patient Health Questionnaire (PHQ9) (9 items)7. Generalized Anxiety Disorder Screener (GAD7) (7 items)8. Suicide Behaviors Questionnaire-Revised (SBQ-R) (4 items)9. The O*NET Short Form Interest Profiler (web-based 60-item) 10. Global Appraisal of Individual Needs Short Screener (GAIN-SS)(23 items), (field testing)

Grant Components

ASL Translation ProcessStep 1 >> Forward TranslationOriginal Language Target Language(English) (American Sign Language)

The original language(in this case, English) is translated to the target language(in this case, ASL).

Step 2 >> Back Translation Original Language v2 Target Language(English-back translated) (American Sign Language)

The target language(ASL) is translated back to the original language(English).

Step 3 >> Back Translation Reconciliation Original Language Original Language v2(English) (English-back translated)

The two English versions are compared to each other to check for consistency in meaning. We are focusing on the meaning – are the English meanings the same? If there was another commonly-used, equivalent term in English it would be acceptable too.

Inconsistencies in the English versions signal a possible problem. Possible problems include mistranslated words, omissions, cultural differences, etc.

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Back Translation Reconciliation-PHQ-9 (Example)

(All based on the past two weeks up until now)

Feeling tired or having little energy

In the past two weeks, have

you felt tired with no

motivation?

In the past two weeks, do you

feel tire a lot and

unmotivated?

Since two weeks ago, have

you experienced fatigue or

lack of motivation?

In the past two weeks have

you been tired or have no

appetite?

In the past two weeks, you

have felt extreme fatigue, and

have had no motivation to do

anything

The last two weeks, do you

feel tired or have "zero or no"

motivation?

ASL Translation Process: Cognitive Interviewing & Field Testing

Cognitive interviews: Staff conducted 1:1 meetings with 20 deaf adults to get feedback on the signed items of each instrument being validated.

Field Testing: Each instrument completed online by 300 VR and 150 non-VR deaf individuals (each compensated for their time).

Field testing doesn’t occur until we satisfactorily complete: Forward Translation, Back Translation(n= 30), Back Translation Reconciliation, Cognitive Interviewing(n= 20).

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The American Sign Language: Screeners, Tests, Assessments, and Resources" (ASL-STAR) portal provides resources that are culturally-appropriate to use when working with deaf and hard-of hearing individuals.

The assessments and screeners focus on career and behavioral health information.

Ability to provide the assessments and screeners to DHH consumers online in ASL, score them and interpret the results.

www.sardiprogram.com - ASLSTAR

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Provider Training

Client Management

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Client Responses

Differences between Accessible and

Specialized Treatment

Accessible and Specialized Treatment

Accessible Treatment Specialized Treatment

Interpreters are provided throughout the day for group, lectures, appointments and informal occurrences in the program.

Treatment is provided by staff fluent in American Sign Language(ASL) and knowledgeable about Deaf culture.

Accessibility devices - video phones, flashing lights for doorbells, vibrating alarm, etc.

Accessibility devices - video phones, flashing lights for doorbells, vibrating alarm, etc.

Materials are adapted as much as possible for DHH clients and an interpreter is available.

Materials are adapted for use with DHH clients (e.g., videos in ASL, reduced emphasis on reading, writing, use of role play, drawing and other techniques)

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DHH Specific TreatmentReasons1. American Sign Language is a visual gestural language with its own grammatical rules and

syntax.2. Language is the primary delivery mode for treatment services and based on cultural experiences.

Best Practices1. Deaf or hearing staff have knowledge of Deaf culture and fluency in ASL.2. Overall program individualized with use of drawing, role play and other visual techniques.3. Accessibility devices-video phones, flashing lights, etc.

Funding Issues1. Accessibility for DHH individuals can be costly.

2. Interpreter costs are not in budgets of treatment facilities.

3. Local services often are not accessible; thus clients must travel to receive services.

4. Insurance challenges i.e. Private, Medicare, Medicaid

Treatment AssignmentsDrug ChartAll drugs usedLast use prior to treatmentConsequences of use

Step Work AssignmentsStep One - Powerless & UnmanageableStep Two - Help & HopeStep Three - Action StepSteps Four & Five – Inventory

Other AssignmentsFeelings collageFeelings journalsSober CitySpirituality workRole plays, videos

Drug ChartStaff Initials______

1. Name all drugs you have used.

2. Last time I used—what? when? how much?

3. When I am high or drunk, bad things happen to me. Things that happen are called consequences.

Draw ____ pictures of body consequences.

Draw ____ pictures of money consequences.

Draw ____ pictures of family consequences.

Draw ____ pictures of law consequences.

Draw ____ pictures of job/school consequences.

Draw ____ pictures of social consequences.

Drug Chart is due on _____________________

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Step One

Step One: Admitted we were powerless over drugs and alcohol and that our liveshad become unmanageable.

Staff Initials

1. Watch the ASL video on Step One. _________Tell 3 things you learned.

2. Draw ____ pictures of how life is unmanageablefrom alcohol/drug use. _________

3. Draw ____ pictures of powerless over alcohol andother drugs. _________

4. Draw ____ examples of how your drug/alcohol use causes problems for other people. _________

5. Draw ____ examples of how your drug/alcohol use causes problem for you. _________

6. Draw one picture how you feel about unmanageable, powerless & hurting people. __________

7. ______ 1:1’s with peer(s). _________8. ______ 1:1 ‘s with staff. _________

Step One is due on _____________________.

You will present your work in group.

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Step Two Assignment

Step Two: Came to believe that a Power greater thanOurselves could restore us to sanity

Staff Initials

1. Meet with Chaplain for Step Two prep. ________2. View ASL videotape on Step Two. ________

3. ___________________________ ________

4. ___________________________ ________

5. ___________________________ ________

6. ___________________________ ________

7. ___________________________ ________

8. _____ 1:1’s with peers ________

9. _____ 1:1’s with staff ________

10. Present Step Two in group. ________

This work is due on ___________________

STEP TWO ASSIGNMENT OPTIONS

The following are options to be used for Step Two assignment. Staff members are encouraged to work as a team to select tasks which best fit the needs and abilities of the individual client. The language may be adapted to fit the individual client.

Step Two Tasks

Keep a daily feelings journal about how it feels to ask for help. Did it help you?

Daily 1:1’s with peers asking for help and record feelings in journal.

List _____ examples of times people have helped me. Draw a picture of how it feels to ask for help.

List _____ examples of ways I am similar to my peers in treatment.

Explain the Serenity Prayer. Include examples of things you can and cannot change.

List _____ people you trust and why you trust them.

List _____ attitudes, behaviors or ideas that have changed since I’ve been in treatment.

Draw _____ places I could go to get support in my recovery.

List _____ skills I have that can help me stay sober.

List _____ things I like about myself.

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Step Three Assignment

Step Three tells us: Made a decision to turn our will and our lives over to the care of God as we understood Him.

Do work in the order written. Get staff to sign before doing the next task.Staff Initials/Date

1. Meet with Chaplain for Step Three prep. (If Chaplain is not available, staff may give permission to view the Step Three prep on videotape.) _________

2. Watch ASL videotape on Step Three. _________

#. _____________________________________ _________

#. _____________________________________ _________#. _____________________________________ _________

#. _____________________________________ _________

#. ________ 1:1’s with peers _______ _______ _________

#. ________ 1:1’s with peers _______ _______ _________

#. Present Step Three in group._________

This work is due on _________________________________.

Step Three Assignment Options Draw one picture of your Higher Power Draw ____ pictures of how your Higher Power helps you The Serenity Prayer says: “Courage to change the things I can”.

Where does courage come from? What can you change? The Serenity Prayer says: “Serenity to accept the things I cannot

change”. Tell what you cannot change. How do you accept that? Draw ______ what my Higher Power wants. Draw ______ what drinking/using me want. Draw ______ what sober me needs. Write/Draw how I contact with my Higher Power. Write/Draw how my Higher Power communicates with me. Write/Draw what Higher Power means to me. Interview _____ people. Ask what their Higher Power is and how it

works in their life. What does spiritually mean? What is the difference between religion and spirituality? What is my will for myself? What is my Higher Power's will for me?

How do I know the difference?

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Polling Question 3

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What was mentioned today that you think is important to consider when working with Deaf & Hard of Hearing Individuals?

A. That writing back and forth is not a recommended approach to use.

B. The importance of having accessible materials for treatment

C. The lack of treatment and aftercare options

D. I had not considered any of the information discussed today

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Online Resources

Recovery Support-12 Step MeetingsOnline 12 Step Meetings in ASL available

https://www.sardiprogram.com/dodameetings/80

Alcoholics Anonymous ASL

This is an American Sign Language (ASL) version of the Fourth Edition of the Big Book, which is the basic text for Alcoholics Anonymous.

This version of the Big Book in ASL is signed by Deaf individuals.

A.A. members maintain personal anonymity at the level of public media.Any person appearing in this video is not an A.A. member.

https://www.aa.org/pages/en_US/alcoholics-anonymous-asl

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12 Steps in ASL : How to Work the Steps

https://www.youtube.com/watch?v=AZtQZeLhvPE

The 12 Steps In American Sign Language-taking the 12 steps in ASL: signed by a certified interpreter. This is from the viewpoint of Dave A. from Austin, Texas, who is off camera to protect his anonymity.

To skip to the step you want to review, see the list of steps below and click on the time next to the step.

Step 1 1:54 Step 2 22:07

Step 3 26.59 Step 4 48.54

Step 5 1:52:57 Steps 6-7 2:16:07

Steps 8-9 2:21:46 Step 10 2:37:26

Step 11 2:43:59 Step 12 3:03:52

Recovery Stories in ASL

https://www.youtube.com/watch?v=yihQPfmGQxU&index=7&list=PLnjWmrSW3LjdCnKz1fkL6RwXOaC7 ZFtnJ

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Recovery Stories in ASL- Bobby’s Story-#1

https://video.search.yahoo.com/search/video?fr=mcafee&p=bobbys+story%2C+asl%2C+deaf+recovery+story#id=2&vid=1c3b3b8b3f50a9e5c13bf212842436c8&action=view

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Recovery Stories in ASL- Bobby’s Story-#2

https://video.search.yahoo.com/search/video?fr=mcafee&p=bobbys+story%2C+asl%2C+deaf+recovery+story#action=view&id=1&vid=07059f7f17b1bf64f2a83e416cc2e6d7

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Drug Awareness Videos12 Steps in ASL86

https://www.youtube.com/watch?v=-ysYVfNKGGg&t=13s

Online Classes on Substance Abuse and D/HH Individuals through Alabama Department of Mental Health Office‐Deaf Services

Classes2Go!“Substance Abuse in the Deaf Community”

facilitated by Deb Guthmann, Ed.D

[email protected]

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Minnesota Substance Use Disorder Program Web Site - www.cddeaf.org

Hands Off Tobacco Prevention Curriculum for D/HH Youth

www.mncddeaf.org

Resources

90Guthmann, D., Titus, J., Embree, J., Wilson, J.(2017). Translation and Validation of an Online Suite of Assessments in American Sign Language. JADARA 51(1), 12-20.

Guthmann, D., & Titus, J. C. (2016). Substance Abuse. In G. Gertz & P. Boudreault (Eds.), The SAGE Deaf Studies Encyclopedia (pp. 932- 935). Thousand Oaks, CA: SAGE Publications.

Guthmann, D. and Sternfeld, C. (2013) Substance Abuse Treatment and Recovery: Adaptations to Best Practices when Working with Culturally Deaf Persons, In N. Glickman’s (Ed.). Deaf Mental Health Care, New York, Taylor & Francis.

Guthmann, D., Lazowski, L.E., Moore, D., Heinemann, A.W., Embree, J.(2012) Validation of the Substance Abuse Screener in American Sign Language (SAS-ASL). Rehabilitation Psychology, Vol. 57(2): 140-148. Guthmann, D. (2011) What to Consider When Deaf Individuals Have Substance Abuse Issues. Paradigm magazine, 16(1) 20-22.

Guthmann, D. (2011) What to Consider When Deaf Individuals Have Substance Abuse Issues. Paradigm magazine,16(1): 20-22.

Guthmann, D., Sandberg, K., Dickinson, J. (2010) An Application of the Minnesota Model: An Approach to Substance Abuse Treatment of Deaf and Hard of Hearing in I. Leigh’s Individuals. Psychotherapy with Deaf Clients from Diverse Groups. Gallaudet University Press, Washington.

Guthmann, D. & Moore, D. ( 2007). The Substance Abuse in Vocational Rehabilitation-Screener In American Sign Language (SAVR-S-ASL) for Persons Who Are Deaf. JADARA. Vol. 41, No.1, 2007. pp. 8-16.

Guthmann, D. & Graham, V. (2004). Substance Abuse: A Hidden Problem Within the D/deaf and Hard of Hearing Communities.” Journal of Teaching in the Addictions. Vol. 3 (1) 49-64.

Guthmann, D., & Sandberg, K. (2003) Culturally Affirmative Substance Abuse Treatment for Deaf Persons: Approaches, Materials and Administrative Considerations. In Glickman, N.and Gulati, S. Mental Health Care of Deaf People: A Culturally Affirmative Perspective. Mahwah, New Jersey: Lawrence Earlbaum.

Guthmann, D., (2003) Steps Towards Recovery: Substance Abuse Treatment for Deaf and Hard of Hearing People.” NADmag, Vol 2, (5) 28-29.

Guthmann, D. & Blozis, S. (2001). “Unique Issues Faced by Deaf Individuals Entering Substance Abuse Treatment and Following Discharge. The American Annals of the Deaf. Volume 146(3), pp. 294-303.

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Resources91Kushalnagar, P., Hoglind, T., Simons, A. N., & Guthmann, D. (2019). Prevalence of Alcohol Use: A National Survey of

Deaf Adults in the United States. JADARA, 52(2), 24-33. Retrieved from https://repository.wcsu.edu/jadara/vol52/iss2/3

Wilson, J., Guthmann, D., Embree, J., & Fraker, S. (2015). Comparing Outcomes from an Online Substance Abuse Treatment Program and Residential Treatment Programs for Consumers who are Deaf: A Pilot Study. JADARA, 49(3), 172-184.

Titus, J. C., & Guthmann, D. (2013). Using evidence-based practices with people who are deaf or hard of hearing. Counselor, 14(3), 68-73.

Titus, J. C., & Guthmann, D. (2010). Addressing the black hole in substance abuse treatment for Deaf and hard of hearing individuals: Technology to the rescue. Journal of the American Deafness and Rehabilitation Association, 43(2), 92-100.

Moore, D., Guthmann, D., Rogers, N., Fraker, S., & Embree, J. (2009). E-therapy as a means for addressing barriers to substance use disorder treatment for persons who are deaf. Journal of Sociology & Social Welfare, 36(4), 75-92.

Thank You!Deb Guthmann

[email protected]

925-788-2852

A N Y Q U E S T I O N S ?

www.naadac.org/identifying-barriers-resources-DHH-webinar

Cost to Watch:Free

CE Hours Available:1 CE

CE Certificate for NAADAC Members:Free

CE Certificate for Non-members:$15

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UPCOMING WEBINARS

Social Media and Ethical Dilemmas for

July 8th, 2020

Counseling Emerging Adults with Substance Use Disorders

By: Fred Dyer, PhD, CADC and Jessica A. Love Jordan-Banks, MHS, CADC


July 10th, 2020

Advocacy Series, Session II: Updates on Federal SUD Funding

By: Robert I.L. Morrison, Executive Director & Director of Legislative Affairs for NASADAD


July 22nd, 2020

Measurement Based Care: An Essential Component of High-Quality Behavioral

Healthcare

By: Julia S. Finken, RN, MBA, CSSBB, CPHQ


August 5th, 2020

Increasing Effective Clinical Supervision for SUD Treatment Providers

By: James Campbell, LPC, LAC, MAC, CAC II and Celeste H. Hutchinson, MA, LPC, NCP, MAC

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Part Five: How to Structure Clinical SupervisionBy: Cynthia Moreno Tuohy, BSW, NCAC II, CDC III, SAP and Samson Teklemariam, MA, LPC, CPTM

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Addiction Treatment in Military & Veteran Culture Specialty Online Training Series


Part One: Supporting Those Who Served – Substance Use and Comprehensive Mental Health for Military Affiliated Populations

Part Two: Supporting Life After Service – Addiction and Transition to Post-Military Life

Part Three: Mental Health for Military Populations – Core Clinical Competencies for Treating Service Members, Veterans, and Their Families

Part Four: Beyond Basic Military Awareness – Cultural Competence in Working with Military Affiliated Populations

Part Five: Identifying Presenting Concerns – Assessment Competencies for Service Members, Veterans, and their Families

Part Six: Using What Works – A Review of Evidence Based Treatments for Military Populations

Series Presented By: Duane K.L. France, MA, MBA, LPC

www.naadac.org/military-vet-online-training-series

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Documents

2020-06-17 Identifying Barriers and Resources DHOH SUD