A Guide to Working with Deaf People in a Health Setting Best Practice Guide Contents Foreword........................................... 4 Introduction...................................... 5 About BID Services........................... 7 What is Deafness? ........................... 8 Degrees of Hearing Loss.................. 9 Statistics............................................ 10 Communication Difficulties............... 12 Methods of Communication............. 13 Deaf Culture...................................... 17 Working with Deaf Patients.............. 18 Interpreting Services........................ 23 Working with an Interpreter............. 25 Communication Tips......................... 26 Useful Contacts................................. 27 Acknowledgements.......................... 28 References........................................ 28 3 Foreword Picture the scenario - you are holidaying in a remote part of the world where people communicate in a language in which you are not familiar. You suddenly find yourself having an illness of a serious nature yet you are unable to discuss your condition because the medical professional treating you have very little knowledge or understanding of your language. It is very likely that you would feel alarmed and worried that you were not able to communicate information about your condition. Now consider this - every day, such a scenario is experienced by deaf people in the UK. Like hearing people, deaf people need in depth and accurate information on their health too, so they can feel included in their medical care. Unfortunately, the majority of health professionals do not have the necessary communication skills or knowledge of deaf awareness to meet the needs of deaf patients. This often results in deaf patients feeling excluded from decisions about their medical care. This needs to change. We would like to see a world in which the communication needs of deaf people are acknowledged and addressed by those responsible for providing services. This booklet developed by the charity BID Services, seeks to provide information and advice on how to communicate effectively with deaf, deafened and hard of hearing people in a medical setting. It provides practical advice on how to bridge the gap between the deaf patient and the care professional and to enable both to work together to provide a sensitive and responsive service to deaf people and their families. I would like to thank BID Services who, as part of its Deaf Cancer Care Project in conjunction with Macmillan, developed this very useful guide. Kind regards 4 John A. Hay, MBE Introduction Modern healthcare places great importance on giving people information to allow them to make healthy choices. Hearing people are bombarded with advice, but we have found a lack of even basic health information in British Sign Language (BSL). Here are some of the statistics: “In this internet enabled world of connectivity, 45% of Deaf people still have to walk into their surgery to make an appointment. When sign language users finally get to see their doctor, they are forced to communicate in ways that cause confusion, misunderstandings, missed diagnosis and poor treatment. 8 in 10 Deaf people want to use sign language, yet only 3 in 10 are given the chance.” (SignHealth, Sick of It Report 2014). “There is a likelihood of reduced life expectancy in Deaf People.” Researchers at the University of Bristol in partnership with SignHealth. “Missed diagnosis and poor treatment is costing the NHS £50 million a year.” Health Economists at the University of East Anglia, commissioned by SignHealth. 5 People who are deaf, deafened or hard of hearing often cope with communication difficulties in everyday life situations. Where there is deafness, challenges exist for both the patient and those providing the care. Healthcare professionals need to obtain information and give advice, and patients need to ask questions and share their concerns. Therefore, to provide an equitable service for deaf people, it is vital that their communication needs should be acknowledged and addressed by those responsible for providing services. This guide seeks to provide information and advice on how to communicate effectively with deaf, deafened and hard of hearing people. It provides practical advice and seeks to raise awareness of the issues faced by deaf people when communicating in a hearing world. For the purpose of this guide and ease of reading, the term “deaf” is used as a general description to refer to those who are deaf, deafened or hard of hearing. 6 About BID Services BID Services is a charity. We work in partnership with people with a sensory impairment, as well as those with a physical disability or mental health. Our mission is to provide high quality services and opportunities that make it possible for people to have choice and control over their lives. An important part of our work is to deliver deaf awareness training and British Sign Language courses to a range of organisations and professionals. Our specialist service areas include Advocacy, Employment British Sign Language Interpreting and Training, Deaf Awareness Training, Specialist Equipment, Residential placements, Social Work, support for Tinnitus and Housing related Services. We work with children, young people and adults. For more information, visit our website www..bid.org.uk. Our Mission “We’re here to make a positive difference to the people we support by offering a range of innovative services that empower people to control their own lives.” “BID Services can provide tailor made British Sign Language courses & Deaf Awareness training, especially aimed at Health & Social Care Professionals.” 7 What is Deafness? Deafness is the result of damage to any part of the ear and the degree of hearing loss depends on the severity of that damage. The implications of a hearing loss vary from person to person and are related to the individual’s circumstances, thus making it difficult to define and classify deafness. Deafness means that the person has some difficulty hearing sounds. Deaf people often cannot speak clearly. Many with a severe to profound loss may not be able to speak at all. Deafness can be seen as a communication impairment rather than merely a loss of sound perception. Therefore it affects all personal, social, educational and business situations. There are various communication methods that are preferred by deaf people and this section of our booklet will explain the terms and definitions regarding deafness, as well as providing an introduction and summary of the preferred language of deaf individuals along with the various methods deaf people use to communicate. Terms such as ‘deaf and dumb’ have been replaced by more accurate descriptions, such as profoundly deaf, deafened and hard of hearing and these are now widely accepted within the Deaf community. “The greatest difficulties faced by deaf individuals are related to problems of language acquisition and the development of a communication system.” 8 Degrees of Hearing loss Some medical terms that are commonly used to measure and explain the different ranges of hearing loss. -10 0 Mild eg. may have difficulties hearing: 10 soft sounds 20 whisper Moderate 30 eg. may have difficulties hearing: soft sounds 40 whisper inside 50 average house 60 conversational Severe speech eg. may have difficulties hearing: 70 noise inside average house conversational speech 80 busy street 90 loud shout Profound eg. may have difficulties hearing: HEARING LEVEL IN DECIBELS (dB) LEVEL IN DECIBELS HEARING 100 whisper noise inside average house 110 road drill conversational speech busy street 120 jet aircraft loud shout 9 Statistics This section gives you quick access to the main headline statistics about deafness, hearing loss and tinnitus in the UK. The total population of the UK is estimated to be around 64.1 million (Based on National Statistics 2013). There are more than 10 million people in the UK with some form of hearing loss, or 1 in 6 of the population. From the total, 3.7 million are of working age (16 - 64) and 6.3 million are of retirement age (65+). By 2031, it is estimated that there will be 14.5 million people with hearing loss in the UK. More than 800,000 people in the UK are severely or profoundly deaf. There are more than 45,000 deaf children in the UK, plus many more who experience temporary hearing loss. More than 70% of over 70 year olds and 40% of over 50 year olds have some form of hearing loss. There are approximately 356,000 people with combined visual and hearing impairments in the UK. About 2 million people in the UK have hearing aids, but only 1.4 million use them regularly. 10 At least 4 million people who don’t have hearing aids would benefit from using them. On average, it takes ten years for people to address their hearing loss. About 1 in ten adults in the UK have mild tinnitus and up to 1% have tinnitus that affects their quality of life. * above information taken from Action on Hearing Loss: 2014 Professionals need to be aware that Deafness is a hidden disability and may not be a presenting factor 11 Communication Difficulties Access to services is a common barrier faced daily by many deaf people. Something simple, like seeing a GP or attending hospital appointments can cause difficulties for many deaf people. The main barrier faced is often that of communication. An all too common example are health issues, where deaf people could be misdiagnosed or receive the wrong medication due to poor communication. This is often