A Deaf Children’s Mental Health Program – At Last – PAH!

By Brad Saunders, Brenda Dean

• Once weekend per month
• Sometimes on Special holiday days (Christmas and March Break)
• Limited to 10 kids
• Kids sleep over at the cottage (Ontario Camp for the Deaf)
• Respite for Parents
• Provides supervision around the clock
• Youth counsellors get together to review the client’s profile

Sometimes, children come to a point of high levels of frustration, and we’ll be there to support them in any way we can. Together, our team will monitor their social interactions, identify positive social skills, will help them to learn to identify their feelings and doing some life skills. We’ll also be doing both indoor & outdoor activities, including; arts & crafts, swimming, hiking, drama and much more! One of our program goals is to provide kids with an opportunity to meet new friends, practice positive interactions and to have fun. We also encourage kids to be involved in activities that enhance self-esteem and positive behaviours.

• 7 to 10 sessions- 2 hours per session
• Once a week per group
• Language stable and able to communicate
• Group can be set up for specie goals
• Program can involve learning about "Bully" and "social skills"
• Social Club can modify the kid’s need and what they need from the program.

This program will provide the opportunity to boost the self-esteem for Deaf kids and will give them the opportunity to be proud of their Deaf identities. These activities will also give children the opportunity to express their feelings and practice resolving conflicts, learning social skills and develop understanding about friendship.

1. Increase Self Esteem

2. Increase Communication

3. Support for Independent Positive Decision Making

4. Conflict Resolution

5. Belonging and Connectedness

Youth Counsellors are CPI and CPR/ first aid trained and ASL– America Sign Language is the primary language in all of our programs.

1) Self Esteem: Carrie

How does a social group increase self esteem?

• Kids have something they belong too. PAH! Staff were surprised that clients themselves thought that being involved in our social club was considered "cool", positive. Clients coming for individual appointments or family meetings sometimes felt stigmatized as "mental" clients. Our clients already feel "different" due to a delay, or history which contributes towards their feelings of isolation.
• Self esteem in group would be promoted by affirming their individual identity in positive ways, from many different approaches, including making up your sign name. One of the youngest and most delayed clients in the girl’s group got much satisfaction naming herself as "judge" and used this name in other groups. Also, activities such as making things, then describing it in front of other group members, affirmed self identity. In the boys group, we worked on making their own boxes for several weeks, a box with an outside, and inside.
• Some activities looked like art therapy or expressive therapy activities. The difference is context. Social club has many positive outcomes and similar goals as a group therapy, but is not designed with the same boundaries. For example, running a therapy group requires confidentiality—difficult to achieve in the residential environment. Opening to deeper issues with peers that one sees everyday is not necessarily helpful for all clients. A social club solves some of these issues.

2) Communication: Carrie

How does group help increase communication?

• Many of our clients are language or developmentally delayed, due to cognitive factors, language deprivation, early childhood trauma, etc. Helping clients to simply express themselves with language, role playing, and non verbal communication in a different arena supported therapy goals such as disclosing to adults/staff/parents when feeling unsafe. An example: A 9 year old girl client named "Jennifer" informed me that one of the other clients had used the peanut butter on her English muffin with out "asking for permission" from staff first. Rather than inform her that she is "tattle tailing" and to stop the behaviour, we discussed what her reasons to let me know were. Later, in individual therapy, we were able to process how she can inform staff "small" things, but has trouble informing adults about "bigger" things, such as sexual abuse and acting out. The fact that she could see the difference was important in her own awareness of herself.

Carrie- Benefits: Positive, accepting environment focusing on supporting positive focus on individual and their feelings. Children used behavioural models, and perhaps come from families who don’t sign. Youth programs give clients another opportunity to practice skills with specific support to "break down" the steps of positive communication.

3) Support for independently positive decision-making: Juan

• Staff will model appropriate leadership skills and will support good decision-making through discussion, activities and their positive reflection.
• Youth counsellors will support children while they learn to avoid negative situations using a positive approach. Youth Counsellors spends time predicting and anticipating conflict situations. The children will also be encouraged to develop their own personal positive solutions to conflict before the problem occurs through games and other activities. One of the best methods is role-playing.
• Youth Counsellors will encourage reflection through role-playing, journals, 1 on 1 discussion or group discussion.

4) Conflict Resolution: Juan

• What happens when conflict occurs between peers? Upset feelings can lead to aggressive behaviour and some just don’t know how to resolve it. Youth counsellors meet the kids and review the issues immediately with them, so a positive solution can be created before aggression erupts. Their Prime Youth Counsellor will follow up before the end of the day.
• Learning about feelings can help children to better identify the causes of their aggression.
• One of the technique we use "wheel of feeling" to help kids how to solve problems.

5) Belonging and Connectedness: Juan

• Peers share same Deaf culture and life experiences
• Youth counsellor as positive role model
• Feel safe place / safe environment to be in

Juan Jaramillo
Child & Youth Worker Coordinator
PAH! Milton,Ont.
Mental Health Services for the Deaf & Hard of Hearing Children & Youth
TTY: 905-878-0164
Fax: 905-875-3007
E-Pager: juanfj@mobile.rogers.com
Web Site: http://www.bobrumball.org/pah.html

It is estimated that there are over 600 Deaf and Hard of hearing children in Ontario with Serious Mental Health Problems

PAH was established to provide service and consultation to a few of these.

Our clients are referred to us because of:

• Depression and other Psychiatric Illnesses Family Conflict
• Attachment Disorder
• Poor Social Skills
• Questions of sexual orientation
• Aggression and poor anger management skills
• Victims and or Perpetrators of Sexual and Physical Abuse
• Abuse of Alcohol and Drugs

The PAH Team consists of 1 full time and 1 part time Child and Family Therapist, 1 Child and Youth Co-ordinator, 1 Social Worker

When we were established 5 years ago, one of our first projects was to set up Mental Health Principles

We have a list of six principles by which we do our work.

They include:

Being Linguistically accessible and Culturally responsive. This includes using ASL and respecting Deaf culture, but we also respect the diversity of our population and use interpreters of other languages eg Urdu when appropriate.

We have worked to increase our capacity to serve the Deaf community and at the same time have worked to increase the capacity of the Deaf community to support Deaf children with Mental Health Needs

We have increased access to specialized service and supports.

Another important component to our work is our Wrap Informed Process.

This process comes from the Wrap Around Process which wraps services around a client and or family.

It is the client and family who determine what services will be most helpful to them.

This has most often taken the form of 1-1 Deaf mentors for the child. This mentor will take the child into the community, focusing on developing and improving social and individual skills.

We also use these funds to support our Social Club and Deaf Youth Retreat. Juan and Carrie will speak about these programs in a few minutes.

We could not do this without the flexible dollars that were built into our budget.

I am going to take a few minutes to tell you about one of our clients who has benefited from our program.

Darlene is a 17 year old Deaf youth who represents many of our clients. She was born to a hearing family, who never learned to sign past a few basic sentences.

She had had behaviour and social problems for many years before the establishment of PAH!

After a year as our client it was determined that she required residential treatment, however there is no program for the Deaf in Ontario.

Therefore PAH! was faced with the challenge of how to access this service for her in the hearing community and to develop the supports that would make this program successful.

Of course our initial concerns were about how would she communicate with the staff and other clients, and how would the treatment be provided?

Eventually, a program was found that was willing to enter this experiment with us.

PAH provided staff training and support around Deaf Sensitivity Training.

A team of mental health interpreters was developed and this team met regularly with the primary therapist

Contact with the Deaf community was maintained by the twice weekly involvement with a Deaf mentor.

Darlene continued to attend a School for the Deaf, so she had daily contact with Deaf peers.

How have things changed?

Over the past 2 years, there has been a reduction in the number of depressive episodes, and a reduction in self harming behaviour.

There has been a reduction in aggression and verbal threats.

Darlene no longer requires 1-1 staffing in the group home or school. In fact she is presently in the last 6 months of a program that focuses on preparing youth for independent living once they turn 18.

Darlene has developed good social skills and has friends in the Deaf and Hearing world.

She can visit home on a regular basis, and although that situation has not changed much, her reaction to it has. She accepts that her family is always going to be that way, and she can not change them, she can only be responsible for herself.

She has held down a part time job for almost a year.

I cannot close this story without commenting how grateful we are to the Ministry of Children’s Services for the financial support they have made available to Darlene.

I have spoken about one aspect of the program. Carrie Cardwell and Juan Jaramillo will now speak to you about the Social Club and Deaf Youth Retreat programs that PAH! runs.

1. Increase self esteem
2. Increase Communication
3. Conflict resolution
4. Support for independent positive decision making

• Clients coming for individual appointments or family meetings may feel stigmatized as "mental" clients. Clients already feel "different" due to their cognitive status, or a traumatic history, which intrinsically contributes towards feelings of isolation.
• When they join a social group, Clients have something positive that they belong to. PAH! staff were surprised to hear that clients informing others that being involved in the social club was "cool".
• For care takers including residential staff, social group can be a "soft sell" to mental health services. A parent not yet ready to meet with a therapist and her child may be open to sending her child to an after school club. After the experience, a caretaker may be more comfortable with the program. Hearing about social club may de-mystify what mental health staff actually do.
• Self esteem in group is promoted by affirming their individual identity in positive ways, from a variety of structured approaches.

Example: in first group, introduce yourself by making up your sign name. One of the youngest and most delayed clients in the girl’s group got much satisfaction naming herself as "judge" and used this name in other groups.

• activities such as making things, then describing it in front of other group members, affirmed self identity. In the boys group, worked on making their own boxes for several weeks, a box with an outside, and inside.
• In social club, some activities are similar to group art therapy or expressive therapy activities, but the context of the "club" is designed with different boundaries than a more clinically oriented group therapy. The emphasis in social club is on building communication skills directly in a social context. The boundaries are less rigid in social club than for a depth oriented group therapy, where confidentiality is critical for client’s emotional safety. Confidentiality is virtually impossible to achieve in a non treatment residential environment. After dropping of the girls in the cafeteria, a client ran to her counselor and excitedly discussed the group’s theme and activities around what is a "good" secret and what is a "negative" secret.
• Clients attending group therapy in a confidential environment don’t tend to know each other and friendships outside the group are not the goals of therapy and may even be discouraged. In a large residential school environment, clients have long established histories with each other. Opening clients to a deeper process in group would be counter-therapeutic. When deeper issues arise, for example, unresolved feelings related to abuse, I may acknowledge the issue, name it, and re-direct clients to their individual therapy to process a memory further.
• Social club is not a therapy group which processes deeper issues. Social Club is a group with structured, planned, therapeutic approaches that directly fosters change, without relying on client insight. As many of our clients have attachment issues, and are language delayed due to a variety of cognitive and environmental factors, we find individual therapy the best treatment approach for working through core issues.

• Many of our clients are language or developmentally delayed, due to cognitive factors, language deprivation, early child hood trauma, etc. Social club supports expression through language, role playing, non-verbal communication, art, team building games. Therapy goals, such as telling adults/staff/parents when feeling unsafe, are supported in a more informal context than a therapy session.
• Peanut Butter vignette A 9 year old girl client named "Jennifer" informed me that one of the other clients had used the peanut butter on her English muffin with out "asking for permission" from staff first. Rather than inform her that she is "tattle tailing" and to stop the behaviour, which is what she is used to in school and residence, we focused on what she felt, and how the other client felt. The group was actively involved in discussion, providing feedback. Here, the emphasis was on the action in the moment, not the underlying reason for behaviour.
• Later, in individual therapy, we were able to process how she is on the right track, communicating to staff when she is feeling uncomfortable. She tells staff about seemingly insignificant issues, but has trouble informing adults about significant concerns related to safety and sexual acting out. The goal of increasing her awareness of her response to fear, losing control, etc. is a therapy goal. The goal of initiating positive discussion is a social club group.
• Social groups gives clients another opportunity to practice skills. Staff help identify, step by step, positive communication. Positive communication of course does not mean expressing only happy feelings, but rather, using communications to show how you feel without acting out.

• social club better for those with language development as a shorter time frame required more language; model suited towards girls who are in general more verbal
• DYR with a longer time frame, room for repetition, and action oriented approach works well for boys.