Developing Mental Health Services For Deaf, Deafened And Hard Of Hearing Individuals

WORKSHOP OUTLINE

Introduction Description of Agency History of Pilot Project Development of Services Implementation Issues

INTRODUCTION:

Ottawa Salus Corporation is a Community Mental Health Agency, funded by the Provincial Ministry of Health. It is a not for profit agency that works with people recovering from severe and persistent mental health problems.

The following vision, mission statement and agency values were developed collaboratively with clients, staff and board members.

Individual and community growth.

To promote individual growth and well-being in the community for individuals with mental health problems by providing quality housing and support services in both official languages.

Ottawa Salus believes that it is important that our work reflect the following values:

Trust, integrity and life long learning.

Trust –that all relationships must be built on trust, caring and respect for individual differences.

Integrity- that people will be treated honestly and fairly, respecting the rich diversity of each person’s experiences.

Life Long Learning- that learning and self-development is a life long process that must be nurtured and cultivated.

"Salus" means well being in Latin and the agency has been incorporated since 1977.

All Salus services are based on a growth and recovery model that is client centered, strengths based with individual interests and goals as the prime focus.

Ottawa Salus began as a small housing organization and over the years has expanded to offer support services as well. As we all know safe, affordable housing is the foundation for good health and is an essential part of someone’s recovery process.

The agency has 2 main functions:

1. Providing supportive housing
2. Providing long term support services

The supportive housing portfolio has a number of housing options:

Three group homes, and 186 individual and shared apartments that are geared to income.

Salus also has a partnership with the Ottawa Housing Corporation to provide on site support in 3 large apartment buildings.

The support services offered are the following:

Case management, receology ,occupational therapy and community development. These are all long term services that assist clients in living successfully in the community. Over the years the support services have become more specialized to better meet the needs of our clientele.

New services added:

1. Concurrent disorder services-these are services for individuals who have a mental illness as well as a substance abuse problem.
2. Case management services to deaf, deafened and hard of hearing people (started in 2000).
3. Franco-phone services-there are 4 case managers that work with French speaking clients and offer all their services in French.

Our interest in working with deaf individuals happened quite accidentally. A deaf gentleman was referred to one of our group homes and was refused based on staff’s inability to communicate with him. The referring social worker challenged the agency by saying it was the staff’s inability to provide services and not the client’s ineligibility that was the problem. This challenge very much changed how the agency viewed our accessibility and resulted in a number of front line staff, taking ASL training. The gentlemen moved in, did very well and staff’s confidence and ability to provide support services to deaf individuals began. Of course it did not take long before word got out that Ottawa Salus was becoming "deaf friendly" and we soon received many housing referrals for deaf individuals.

The agencies that provide services to the deaf community (CHS, ODC to name 2) identified the need for specialized mental health services and were very concerned that clients could not access these essential services that were offered to the hearing population. The concerns were the following:

1. there were no psychiatrists proficient in ASL in the Ottawa area
2. there were no accessible drug and or alcohol treatment programs
3. specialized mental health services were not offered

Based on the lack of services, a number of interested stakeholders lobbied the provincial government to provide funding for services for deaf individuals with a severe and persistent mental illness. (agencies: CHS, CMHA, Ottawa Salus).

In March of 2000, the Ministry of Health provided funding to provide case management services to deaf individuals. They also provided funds for sign language interpretation to support the services. This provided funds for 2 full time mental health workers (case managers) at Ottawa Salus to provide services to approximately 20 clients and 1 full time interpreter at CHS.

The model of service delivery was for 2 workers to provide service within the client’s culture (deaf, oral based on client) and to have the support of a full time sign language interpreter to assist both the workers to work more comprehensively with the system and the client to access services in the community. This was a group of people who had rarely been served before and who had been greatly marginalized and neglected. As part of the preparation to lobby for these funds, it had been determined that the numbers of potential clients could be as many as 520.(10% of general population are deaf, deafened and hard of hearing and 2% of general population have a severe and persistent mental illness).

All the stakeholders were thrilled at the funding announcement and Salus very quickly developed an implementation plan. As was to be expected the implementation of the plan took much longer than expected for a number of reasons.

The first hurdle was to recruit 2 staff who were highly skilled in mental health and were proficient in ASL. This proved to be a very difficult task. There were many skilled personnel but very few who had both specialties. After consulting with our colleagues within the deaf community, it became obvious that Salus needed to develop ASL skills. We had a number of staff who had some proficiency and 2 staff came forward to take on this new challenge. They were very willing to take on the time consuming and stressful challenge of enhancing their language skills in a short time frame. Accessing language courses in the community did not prove easy, particularly at the more advanced levels of language training. Often courses were offered but did not materialize because of low enrolment. Due to time constraints we decided to offer 1:1 ASL tutoring and this proved to be an excellent choice. We used 2 different tutors and the level of instruction and the rapid skill development was a great investment in time and dollars. The other advantage of individual tutoring was the course content was tailored to the nature of the work. For example there are a number of terms that are frequently used in the mental health system and we were able to tailor our learning needs with the tutors.

At the same time that the staff was being trained we also did some agency training to enhance our capacity to be accessible to this population. We collaborated with our colleagues within the deaf community to provide agency workshops, which were informative and fun.(see hand out). Typically deaf individuals have received their services at CHS whose agency culture is very user friendly. The new partnership Salus had with CHS broadened the mandate for both agencies in becoming more comfortable with this new clientele. Salus provided support and education for CHS in how to support clients who have significant psychiatric problems and helped them become familiar with various signs and symptoms that clients often struggle with.

DEVELOPING A PROFILE WITHIN THE DEAF COMMUNITY

The challenge to recruit clients was the next step in the overall process. Typically clients who need/want case management services, complete a referral form and are put on a central waiting list at CMHA. CMHA has not been a typical agency or resource identified by the deaf community nor seen as a leader in services to this sector.

There was some apprehension from the deaf community about this type of service opening up to deaf individuals, outside of the traditional deaf culture. There was also reluctance to access an agency identified clearly as a mental health agency with the accompanying stigma, that can be associated with their services.

Given all the obstacles, it became obvious that the new workers needed to start building a profile of confidence and trust within the deaf community. The plan was to become more visible by doing a number of volunteer hours at a community agency that offered a variety of services targeted to the deaf community. This turned out to be a great idea and very enjoyable for the staff.

The time spent at the center served a number of purposes:

1. The various activities and relationships provided multiple opportunities for staff to practice newly acquired ASL skills
2. Staff slowly built a visibility within the deaf community
3. People became interested in the staff’s employment and asked about the services offered. They often became referral sources for friends and colleagues who could use the services.
4. The volunteer work as well as the informal outreach to potential consumers helped decrease the apprehension and perceived stigma of ‘mental health services’.

The volunteer work was seen as an outreach activity as the Salus staff were approaching potential clients and providing information on potential services. Initially clients very much wanted access to services like financial aid or housing and a lot of the early work was linking people to the services that they needed.

A call out was made to the providers of deaf services in both counseling and day programs, as well to the more mainstream hospital and community service providers to advise them of the new services and to elicit referrals.

In a short period of time we received a number of referrals, both formally from within the professional hearing community as well as directly from the deaf community. It is very interesting to note that in spite of all of our concerns about stigmatizing potential clients with the label of ''mental illness', very few consumers have been concerned about being identified as mentally ill. The model of case management that Salus uses is a portable, flexible service where clients are seen in their preferred location, often in their own homes. As well a number of clients prefer to have their appointments at our Head Office, which has a small sign ‘Ottawa Salus’, with nothing identifying the building as a mental health agency

This has been an exciting and rewarding project to undertake. There was a huge agency learning curve to become comfortable and knowledgeable in being an accessible agency.

In any new project there are always 2 processes at work at once, the project (content, the ‘what’) and the process (the ‘how’).

The details of the actual project were all the technical steps outlined earlier.

1. Staff recruitment and training
2. Enhancement of agency capacity to service target population
3. Developing a profile within deaf community
4. Linking, outreach
5. Direct services

Review of Process:

As we know from experience the process is as important if not more than the actual project. The personal relationships and networking that we sometimes take for granted are what ‘make or break’ a partnership. Things can look perfect on paper, but it is up to the people to operationalize the project. All relationships are fraught with politics and potential for conflict. It may seem obvious but it is very important to nurture the partnership relationships and be prepared to put in the time and effort it takes to have a successful partnership.

1. Choosing who you will have a relationship with: Often as agencies we find ourselves working with colleagues that have different mandates, different missions and very different agency cultures. In our partnership with CHS, we were very fortunate in that we both had a common goal-developing services that had not existed before.
2. Getting to know your partner: It is critical that you get to know :the strengths and weaknesses, of each other. It is important to develop ways of achieving mutual goals and developing complementary services.
3. Maintaining good relationships: It is obvious that there will be ups and downs and occasions that there will be areas of conflict. Discussing a crisis resolution format before the partnership begins will help, once the implementation process has begun and conflicts arise.
4. It is interesting to note that the Ministry of Health is very much promoting service agreements between agencies. These agreements are merely taking informal ways of working and making them explicit in written agreements. Historically we often worked with community partners with no formal written agreements however in a climate of enhanced accountability, service agreements have become the norm.
5. On going evaluation process with a built-in feedback mechanism to revise services as needed is another essential ingredient for good management

Refer to Handout #2

This handout is a quick reference an agency might want to use if you are considering, expanding your services.

We have looked at the process of developing specialized services and now we will look at the actual delivery of services.

Paul Boileau is one of the Salus case managers who is specialized in working with deaf, deafened and hard of hearing individuals. He has a wealth of experience and will talk about some of our learning’s at Salus.

1. Members of deaf community

-deaf, deafened and hard of hearing
-oral versus culturally deaf

2. What is ASL?

-history
-MSL, LSQ etc.
-finger spelling
-discourse structures-English versus ASL

3. Technology

-closed captioning
-TTY
-hearing aids, cochlear implants etc
-clock alarms
-smoke decoder
-Bell Relay

4. Deaf Culture

-social rules of behavior
-introductions
-attention
-leave taking
-name signs

5. Group norms
6. How to use an interpreter