Integrating_primary_care_and_behavioral.pdf

Health care marginalization of the deaf community

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Health care marginalization of the Deaf community results from a complex interaction of barriers and experi- ences across multiple levels of the social-ecological matrix (Smith & Chin, 2013). Examples include communication barriers between clinicians and deaf patients and their families (including insufficient access to medically quali- fied sign language interpreter services); a limited “fund of information” among many deaf persons regarding biology, disease, and health care (Pollard & Barnett, 2009; Pollard, Dean, O’Hearn, & Haynes, 2009); deaf persons’ frequently limited knowledge of family medical history and con- strained expectations regarding the patient role (stemming from communication barriers within the family and be- tween deaf youth and clinicians); and the parallel limited fund of information among many clinicians regarding how to work effectively with deaf persons and sign language interpreters. The frequent result is that clinicians, deaf patients, and their families all abide a status quo of inade- quate patient comprehension and engagement during clin- ical encounters. Deaf individuals’ access to quality health and mental health care varies greatly across the United States. Cities with large Deaf communities may have some deaf and hearing clinicians with ASL fluency and the requisite knowledge, but their offices are typically isolated pockets of access and competence and do not imply broader, sys- tem-wide know-how in those regions. Notably, states with the best system-wide reputations for Deaf population men- tal health care (e.g., Alabama, North Carolina, and South Carolina) invariably achieved this only after litigation forced the public mental health system to address aggrieved Deaf plaintiffs’ needs (usually via the Americans with Disabilities Act [ADA] of 1990), leading to improvements benefiting many other Deaf and even hearing consumers. Given the differing ways publicly funded physical care 4 In keeping with contemporary writing practices in the deafness field, the uppercase “D” is used when referring to deaf persons as a specific sociocultural group, and the lowercase “d” is used when the intent is a more general reference to people whose hearing loss precludes auditory communication. While acknowledging the Deaf community’s heterogeneity, the capitalized term is generally understood as referring to persons who have hearing loss in the severe to profound range, prefer to communicate in sign language, and otherwise demonstrate social and cultural affiliation with the Deaf community. 384 May–June 2014 American Psychologist
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versus mental health care are managed, statewide improve- ments such as these have no counterparts in the primary care system. Adults deaf since birth or early childhood report higher rates of obesity, suicidality, and intimate partner violence (Barnett, Klein, et al., 2011), as well as adverse childhood experiences that would benefit from an inte- grated, collaborative approach to care. Care integration beyond Doherty et al.’s (1996) Levels 1 or 2 (see Table 1) virtually never occurs for deaf persons in the United States.
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  • Fall '18
  • kioli
  • Health care provider, Doherty

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