Communicating with the Deaf & Hard of Hearing Culture

HS 533 Intercultural CommunicationsConcordia University

Brittany Serpico22 August 2013

Why focus on deaf & hard-of-hearing?

I’ve been working with elderly persons for seven years and I have witnessed many types of subcultures within the elderly population. In regards to barriers in communication, the subculture of the deaf and hard-of-hearing came to mind.

One in six Americans has impaired hearing, with higher prevalence among the elderly (Bade, 2013). In my personal experiences of communicating with these older adults who are hard-of-hearing has made communication and understanding very difficult in helping to provide services to these clients.

I have had trouble communicating over the phone either because they are hard-of-hearing or the phone line distorts the sound on either side of the line.

It’s apparent that I need to promote awareness and obtain knowledge of services that can be available to these particular clients so that communication may be clearer between client and the helping professional.

Why focus on deaf & hard-of-hearing (continued):

Older adults’ hearing loss creates not only a communication barrier, but also continuous stress over the inability to react and respond appropriately (Dewane, 2013).

Poor hearing is often the cause of misunderstandings and negative reactions by communication partners, yet fewer than 24% of people who could benefit from hearing aids actually purchase them (Yorkston, et. al., 2010).

Communication is not just about exchanging information and transferring messages. Communication with others outside one’s own culture also serves an important role in establishing and maintaining social affiliation and social awareness. If communication is compromised, social life is also affected.

Introduction: “People with hearing impairment make many self-defining choices-

of communication method; language; and social, cultural, and political allegiance” (Luey, Glass, & Elliott, 1995, p. 177).

Most of the late-deafened and hard-of-hearing population are older adults who grew up learning language, reading, and writing, and then gradually lost their ability to hear well or they became deaf over time (“Deaf and Hard-of-Hearing”, 2013).

American Sign Language is the most commonly spoken sign language in the U.S. People who communicate verbally and also use sign language are considered bilingual (“Deaf and Hard-of-Hearing”, 2013).

Introduction (cont.):

Culturally deaf and late-deafened or hard-of-hearing persons are distinct populations with different needs and strategies (“Deaf and Hard-of-Hearing”, 2013).

People who grew up deaf tend to claim the identity of being Deaf, assert their civil rights, and expect accommodations for their hearing loss; on the other hand, late-deafened people have not been conditioned to assert these same rights (“Deaf and Hard-of-Hearing”, 2013).

Through language, cultural exchange takes place by every individual who shares stories that are retold over and over again (Avon, 2006). Sign language develops its own culture by uniting the deaf people who tell their cultural stories in this language.

People whose primary language is ASL tend to come together to form a culture of their own.

According to Glass and Elliott (1995), many people marry within the culture and affiliate with formal and informal organizations that are part of it. In addition to language, the culture includes particular behaviors, norms, and beliefs (Glass & Elliott, 1995).

What is culture: Culture- the entirety of ways of living, including behavioral norms,

linguistic expression, styles of communication, patterns of thinking, and beliefs and values of a group large enough to be self-sustaining transmitted over the course of generations (Jandt, 2010).

Definitions:

Culturally deaf- born deaf or became deaf at an early age. May have grown up with deaf parents, lived within a deaf community, learned to communicate using sign language, and/or developed the skill of speech reading (lip reading) (“Deaf and Hard-of-Hearing”, 2013).

Hard-of-hearing:-hearing loss ranging from mild to profound; depend primarily upon spoken language when communicating with others; may benefit from use of hearing aids or other assistive listening devices (“Deaf and Hard-of-Hearing”, 2013).

Late-deafened- profound hearing loss that occurred after development of speech and language; derive little benefit from hearing aids or other assistive listening devices (“Deaf and Hard-of-Hearing”, 2013).

Misconceptions: Avon (2006) found in PBS.org’s chronicles that Plato assumed that

those who could not speak showed no proof of intelligence; therefore, he concluded that they were not capable of having ideas or language. The deaf language was misunderstood and perceived by some scholars as being incomplete.

Later they discovered that it was indeed a complete language of its own. The deaf community became accepted as their own community; as a linguistic and cultural entity (Avon, 2006).

Deaf people were also misconceived as “unhappy deaf people” (Avon, 2006). Deafness was also perceived as something to be cured.

Misconceptions (continued):

During the years of silent films, both hearing and deaf audiences could appreciate the film equally. Later, films focusing on deaf people used deafness as a tool for humor.

Eventually, some films came out that portrayed deafness as an accepted culture and displayed the beauty of sign language.

“It must be understood that film depictions are only one person’s interpretation and it is the viewer’s responsibly to separate the creative aesthetics of film production from the small element source based on reality” (Avon, 2006, p. 202).

In conclusion, there needs to be an appreciation of the history, formation, and reality of the Deaf culture.

Differences between deaf & Deaf:

An estimated 6.2 million people currently living are prelingually deaf, and many of these have formed Deaf communities, often with distinct languages and cultural practices (Senghas & Monaghan, 2002).

Understanding the complex nature of communities with deaf members requires attending to how people use and think about language; in other words, people need to understand the culture of language (Senghas & Monaghan, 2002).

According to Senghas and Monaghan (2002) the growing field of Deaf studies has its own terminology.

I learned that there is a distinction between Deaf and deaf. Separating audiological issues (that is, measurable hearing levels—deaf and hearing) from those of socialization, acculturation, and identity (Deaf as sociological or cultural reference) makes otherwise confusing issues far more understandable (Senghas & Monaghan, 2002). For example, those who lose their hearing late in life might be considered deaf but not Deaf (Senghas & Monaghan, 2002).

Differences between deaf and Deaf (continued):

There are also distinctions in signs and sign languages. “Linguists have developed clear distinctions between natural sign languages (i.e., sign languages not consciously invented), artificial sign languages, gesture, and homesign” (Senghas & Monaghan, 2002, p.74). For example, “finger spelling systems are basically written alphabets represented in a signed modality and may employ one-handed (such as the one used with ASL) or two-handed forms [such as that used with British Sign Language (BSL)]” (Senghas & Monaghan, 2002, p. 74-75).

There are also differences in perceptions of deaf and signing communities. “The most promising theoretical issues can be categorized into general areas: agency and models of deafness, child socialization, imagined communities and social networks, linguistic (speech) communities, language and linguistic ideologies. World Systems, and global cultural flow” (Senghas & Monaghan, 2002, p.77).

Senghas & Monaghan (2002) conclude that the past twenty years have shown a remarkable increase in the research on sign languages and d/Deaf communities.

Advocating for the deaf and hard-of-hearing:

According to a case study by Desselle and Proctor (2000), a hearing impaired 77 year old woman and her grown daughter meet with a social worker who does not put much effort into communicating with the older woman, who is her client. Instead, the social worker communicated directly to the client’s daughter. The daughter was angry because the social worker treated her mother as though she were not aware of the situation.

It is important to understand that those who are hard of hearing do not necessarily hear better with hearing aids. Rather, one needs to be patient and speak slowly and clearly to a hearing impaired person.

When dealing with people with hearing loss, it is important to use one of the basic principles of social work: empowerment with dignity (Desselle & Proctor, 2000).

Improving communication:

Do not shout or yell to the client, instead speak louder and be enunciate words slowly and clearly when facing the client so they can see your face and maintain eye contact (Desselle & Proctor, 2000).

Check with the person to see if he or she understood what was being said. If they do not understand a phrase, try saying it in another way.

Desselle and Proctor (2000) also mention that it is very helpful to teach clients that they should be more assertive and develop a sense of humor when conversational errors occur or to be aware that those who are not hearing impaired may come off as inconsiderate or behave in a way that may be offensive (Desselle & Proctor, 2000).

Using tactics such as these will improve communication between the hearing and the hearing impaired person.

Useful Technology: Coping devices for hearing impairment: A telephone

device for the deaf (TTD), also called a text telephone is attached to a keyboard in which the person can type a message and read the sender’s message on a screen (Desselle & Proctor, 2000).

There are alarms with flashing lights: doorbell, smoke alarm, clock alarm to wake the person, and even baby monitors (Desselle & Proctor, 2000).

Televisions now have captions for those with hearing impairment.

Hearing dogs provide companionship to their owners and also alert their owner of sounds (Desselle & Proctor, 2000).

Practical Strategies: Create the best environment for communication; for example: reduce or

eliminate background noise as much as possible, be sure one’s face is in proper light so that the person can see the face and mouth, and choose locations where acoustics are best, such as carpeted floors (LeJeune, et. al., 2003).

Adjust one’s communication style; for example: write down difficult words that are hard to understand, explicitly announce topic changes, and look for other options to convey names and numbers to those with vision and hearing loss (LeJeune, et. al., 2003).

Make the most of the encounter; for example: find a time that the person is most alert (LeJeune, et. al., 2003).

Suggest tips for the hearing impaired person; for example: avoid pretending to understand if you don’t and identify barriers in communication so that strategies can be developed to overcome them (LeJeune, et. al., 2003).

These technical strategies can be used in both one-on-one and group communication.

Implications for the Social Worker:

Hearing loss is a fact of life for many older adults and social workers tend to be ill prepared for dealing with this challenge (Desselle & Proctor, 2000). The major implication for social workers is awareness (Desselle & Proctor, 2000).

A social worker should have a professional interpreter on hand if needed. According to Luey, Glass and Elliott (1995), effective communication will require the involvement of a fully qualified, professional interpreter and possibly consultation from a specialist in deafness.

It is not appropriate to use a family member as a volunteer interpreter because it may violate a client's right to privacy and introduce bias into the communication process (Luey, et. al., 1995).

A social worker or any helping professional dealing with the hearing impaired or deaf persons must understand the client in a full and multifaceted exploration of all pertinent dimensions of his or her life, including the following aspects: hearing, communication, language, and culture (Luey, et. al., 1995).

The helping professional must be patient because this understanding is crucial in order to develop a positive relationship, for assessing needs accurately, and for delivering high-quality service (Luey, et. al., 1995).

What is GLAD? The Greater Los Angeles Agency On Deafness, Inc., known as GLAD, has been

improving the lives of the deaf and hard of hearing since 1969 and is founded on the philosophy, “of, by, for and with the deaf and hard of hearing” (GLAD, 2013). GLAD’s Deaf Community Center offers a wide-ranging variety of specialized health and human service programs.

The mission of GLAD is to assure equal access for the deaf and hard of hearing community to the same opportunities that are available to the hearing community (GLAD, 2013). The general purposes and efforts are directed around the promotion of the social, recreational, cultural, educational, and vocational welfare of the deaf and hard of hearing consumers (GLAD, 2013).

GLAD’s specific and key purpose is to act as a coordinating agency that attends to the broad social service needs of deaf and hard of hearing people through direct service provision, advocacy, research, and distribution of information regarding deafness to parents, professionals, and consumers (GLAD, 2013).

GLAD Departments: Glad has six general service departments: Human Services, Health

Education, Employment, Public Relations, Senior Housing, and LIFESIGNS, INC.

The Human Services department provides services such as communication assistance (such as using videophones or translating documents), peer counseling, advocacy, independent living skills, employment assistance, information and referral, community education and outreach (GLAD, 2013).

In the Health Education department, they have a teen pregnancy prevention program, breast cancer research and education, health care access coalition, as well as an HIV/ AIDS program.

In the Employment department, not only do they provide assistance in job searching, but they also provide free interpreters for job interviews, assistance in writing resumes, cover letters, and applications, as well as advice on communication access on the job. They also provide support for employers such as free training on communication access technology and sensitivity awareness, information on tax credits, and pre-screening of applicants.

GLAD Departments (continued):

The Public Relations department takes on many forms from donor relations, public affairs and agency communications to promotions, marketing, and consumer relations (GLAD, 2013). This department also holds Sensitivity Trainings on the following topics: population figures, culture, Americans with Disabilities Act, communication access technology, communication methods, how to use interpreting services, GLAD resources, and commonly used signs (GLAD, 2013).

The Senior Housing department currently has a waiting list for the GLAD’s Community Center, which has fourteen apartments for low income senior citizens (GLAD, 2013). The Deaf Affordable Housing Corporation (DAHC) is a program operated at GLAD under Section 8 of the Federal Housing and Urban Development (HUD) Department (GLAD, 2013). Requirements for the program are as follows: applicants must be deaf or hard of hearing, over 55 years old, and meet qualifying income guidelines (GLAD, 2013). 

LIFESIGNS, Inc. is a non-profit, tax exempt California corporation providing communication access to the deaf, hard of hearing and hearing communities (GLAD, 2013). 

GLAD (personal experience): The first time I ever heard of GLAD was when they came to my former job at a

family restaurant to raise money during their fundraiser. I remember not knowing how to communicate with the deaf and hard of hearing customers at first. Many of them wrote down on a piece of paper what they wanted to order. Others were able to speak to me what they ordered. I confirmed their order by reading it back to them. They did not look at my eyes as I was used to with hearing customers; instead, I noticed that I had to make sure they could read my lips and they could confirm the order was correct with a nod of their head.

Communication with this group was difficult at first, but every month they came in for their fundraiser so I grew more comfortable communicating with this culture group.

On one occasion, I saw one of my friends mingling with the GLAD group. My friend is deaf in one ear, so she practices her sign language with GLAD members and is going to college to be a professional interpreter some day.

In my future career goals, I would be able to use their services for my clients who are hard of hearing or deaf. Since my goal is to work with elderly persons, I can expect many of my elderly clients to be hard of hearing or deaf due to health issues or age. If I ever have the time to learn sign language, this agency would be a great place to contact first and I would be able to refer my future hard of hearing or deaf clients to this agency for better assistance in all life situations.

Intergenerational Communication:

I began working as a caregiver at the age of 18. At first, I did not know how to communicate with the elderly due to the age and culture differences. Now, at age 25, I still find that I have much to learn about how to communicate with deaf and hard-of-hearing persons.

Most of them were hard of hearing and have had hearing aids or cochlear implants. These did not always help their understanding of what I said because the sounds were not clear even if I raised the volume of my voice.

In casual conversations, my clients enjoyed telling me stories about their past- where and how they grew up.

They would tell me what life was like during the war and the Great Depression and how things are so different now a days. I used those topics to base conversations because I found it easier to talk about topics they were familiar with or interested in.

One client surprised me when she asked me if I had a Facebook account. She is in her early 80s and has her own Facebook account so that she can stay connected through the internet with her friends and family that she doesn’t get to see very often due to geographical distance.

Some things I’ve learned: I found it helpful to give the elderly person

options: For example: rather than asking, “What do you want to drink?” It’s best to ask, “Do you want coffee or juice?”

Don’t jump from topic to topic. Stay on one topic until a clear transition is made.

Speak with short, simple sentences. Give the person time to understand what

was said. Don’t rush them to respond.

References: Avon, A. A. (2006). Watching Films, Learning Language, Experiencing Culture: An Account of

Deaf Culture through History and Popular Films. Journal of Popular Culture, 39(2), 185- 204. doi:10.1111/j.1540-5931.2006.00228.x.

Bade, P. (n.d.). # 241 Improving Communication When Hearing Loss is Present. EPERC. Retrieved August 4, 2013, from http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_241.htm

"Deaf and Hard-of-Hearing - health care issues | Culture Care Connection.“ Culture Care Connection - Stratis Health | UCare. N.p., n.d. Web. 22 Aug. 2013. <http://culturecareconnection.org/matters/diversity/hearing.html>.

Desselle, D. D., & Proctor, T. K. (2000). Advocating for the Elderly Hard-of-Hearing

Population: The Deaf People We Ignore. Social Work, 45(3), 277-281. Dewane, C. (n.d.). Understanding Hearing Loss. Today's Geriatric Medicine - News &

Insight for Professionals in Elder Care. Retrieved August 3, 2013, from http://www.todaysgeriatricmedicine.com/archive/050310p16.shtml

GLAD Mission – GLAD - Greater Los Angeles Agency on Deafness – Full social service

agency, including interpreter referral. Administers NAD evaluation to interpreters. (n.d.). GLAD - Greater Los Angeles Agency on Deafness – Full social service

agency, including interpreter referral. Administers NAD evaluation to interpreters. Retrieved August 8, 2013, from http://www.gladinc.org/about-glad/glad-mission

References (continued):

Jandt, F. (2010). An introduction to intercultural communication: Identities in a global community, (6th ed.). Thousand Oaks, CA: SAGE Publications.

LeJeune, J. J., Steinman, B., & Mascia, J. (2003). Enhancing Socialization of Older

People Experiencing Loss of Both Vision and Hearing. Generations, 27(1), 95. Luey, H., Glass, L., & Elliott, H. (1995). Hard-of-Hearing or Deaf: Issues of Ears, Language,

Culture, and Identity. Social Work, 40(2), 177-181. Senghas, R. J., & Monaghan, L. (2002). Signs of their Times: Deaf Communities and the

Culture of Language. Annual Review of Anthropology, 31(1), 69-97. doi:10.1146/annurev.anthro.31.020402.101302

Yorkston, K., Bourgeois, M., & Baylor, C. (2010). Communication and Aging. Pubmed

Central, 21(2), 309-319. Retrieved August 3, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074568/