Serving Clients with Hearing Loss: Best Practices in Mental Health Counseling

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According to the National Association of the Deaf (NAD; 2003), more than 28 million Americans have some degree of hearing loss. Three out of every 1,000 infants are born with a hearing loss, the most prevalent birth defect in the United States (National Center for Hearing Assessment and Management, n.d.). Individuals with hearing loss vary greatly depending on individual degree of hearing loss, age of onset, use of assistive devices, and means of communication. Individuals with hearing loss are also diverse in respect to economic status, age, gender, sexual orientation, and ethnicity. This article first provides an overview of the characteristics and risk factors of the population who are deaf and hard of heating and then discusses several counseling models and interventions for mental health counselors serving clients with hearing loss to use in addressing and minimizing these risk factors.

* Client Characteristics and Risk Factors

Individuals with hearing loss are too often socially isolated within their homes, schools, workplaces, and communities. Common barriers individuals with heating loss face include communication problems, inequitable access to health care and education, low literacy, and underemployment. As a result of familial and personal conflicts, spoken or unspoken, and peer and societal discrimination, individuals with hearing loss often feel inadequate and alone, with few resources and means of support. Individuals with hearing loss often have to acculturate to the hearing world, resulting in a loss of personal identity and group identification. This is particularly true of persons with hearing loss who are gay, lesbian, or transgender; immigrants; minority status citizens; and individuals from lower socioeconomic backgrounds (Myers, 1995). For these individuals, their lowered sense of self-reliance is reflected in poor self-esteem; they may use self-defeatist and self-handicapping strategies, which further contribute to a negative self-fulfilling prophecy. Finally, a high external locus of control for individuals with hearing loss, particularly adolescents, often results in learned helplessness, depression, and suicidal behavior (Critchfield, Morrison, & Quinn, 1987). This article subsequently addresses these barriers and makes recommendations to mental health professionals for improving the quality of treatment for clients with hearing loss.

Health Care

For individuals with hearing loss who seek mental health counseling, there are several current barriers to treatment. Clients with heating loss must sometimes pay exorbitant amounts of money for the evaluation and provision of appropriate mental health services by a qualified psychiatrist (Critchfield, 2002). Additionally, mental health professionals are typically unprepared to meet the needs of clients with hearing loss. Communication barriers and access to interpreter services are also a major concern for individuals with heating loss who seek psychotherapy. In consideration of these barriers, persons with heating loss are therefore less likely to seek and be able to afford mental health counseling.

The average lifetime cost for each individual with hearing loss is estimated to be $417,000 (National Center on Birth Defects and Developmental Disabilities, 2004). Individuals may not have the option of pursuing second opinions by qualified specialists because of insurance coverage restrictions and limitations of specialist availability and locality. Depending upon the quality and scope of individual medical insurance, coverage for various specialist services may be restricted (Garber, 2002). Reimbursement rates are particularly low for Medicare and Medicaid recipients and are often insufficient to cover the costs of audiologists' services (Garber, 2002). Surprisingly, heating aids are not covered under Medicare, even though more than one third of the nation's older population has significant heating impairment by age 65 (Garber, 2002; U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, 2007).

Education

According to NAD (2003), "normal adjustment, cultural, language, and communication issues are often mistaken for developmental delays, mental illness, or mental retardation" (para. 6) when working with individuals with heating loss. Misdiagnoses and misunderstanding among professional staff in educational and mental health care systems are unfortunately all too common in the treatment of individuals with heating loss; clients with hearing loss are often labeled by mental health professionals as low-functioning with minimal language skills, disabled, or handicapped (Sussman & Brauer, 1999). All of these circumstances create sizable gaps in learning, communication, and skills acquisition for children with hearing loss.

Within the public school system, students with heating loss may opt to learn via inclusion, special education, or supportive services. Students with heating loss must have both a significant hearing impairment and qualify for special education in order to receive related services such as speech therapy, social work, and counseling (Individuals With Disabilities Education Act Amendments of 1997). Individuals with hearing loss are often socially isolated and have difficulty communicating with hearing persons, particularly for students participating in special education programs in school systems where special education classes are held separately. In addition, students with heating loss may have multiple disabilities, emotional difficulties, and behavior problems that educational systems are unprepared to address. Students with hearing loss are also in need of supplemental educational services, which include career exploration, independent living skills, communication skills, and social skills, in order to better prepare for the workforce. School counselors may not have the time or specific training to assist students with heating loss with skills acquisition.

Weighing the benefits and costs of alternatives to public school education is a difficult decision-making process for most families. All states provide appropriate educational services at schools for students who are deaf. However, state schools for students who are deaf may be located far from home, and parents may be reluctant to send their children to live at residential schools (Hands & Voices, 2005). A remote living arrangement may further alienate family members and friends from the child with hearing loss. Second, youth who are hard of hearing or who have mild hearing loss may not identify themselves as deaf and may be uncomfortable in a setting exclusively for individuals who are deaf.

Literacy

In 2002, approximately 69.4% of all students with heating loss in the United States graduated with official high school diplomas (Bradshaw, 2002). However, the average reading level of high school graduates who are deaf is at a third- or fourth-grade level (Paul, 1998, 2001). According to several statistical studies, 17- and 18-year-old students who are deaf read, on the average, at an equivalent to fourth-grade level (Gallaudet Research Institute, 1996; Hardwell Byrd, 2004; Holt, Traxler, & Thomas, 1997). These statistics may be attributed to delayed learning caused by communication barriers; a shortage of early intervention programs; inadequate teacher …