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EFFECTIVE ACCOMMODATIONS & HEALTH EQUITY

Medical Equipment on Desk

After reading this website, you know there is a need, and you now know
the Greater Deaf Community is packed with people of all shapes and sizes
having a vast array of unique communication needs and preferences.
Let's now dive into how to serve them!

ARTICLES: 
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PREPARE

YOUR 

OFFICE

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PREPARE YOUR

STAFF

WELCOME NEW
PATIENTS

PREPARE YOUR OFFICE / HOSPITAL

Start with casting a vision

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By encouraging active participation, patient engagement can result in better adherence to treatment plans, better outcome, and fewer adverse events. Active patient engagement can help to enhance patient-provider relationships, foster trust, and increase patient satisfaction.

Deaf individuals surveyed generally report that they often don't understand information conveyed, they often do not feel they have effective access, and they often feel pressured to make decisions they wouldn't have otherwise made if there was a well fostered and positive doctor/patient relationship.

Create a D/HH Communication Action Plan

Evaluate each point of contact for accessibility limitations.

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Make sure these key questions can be answered:

  1. How will they communicate to make an appointment?
    Can it be done independently online?
    If so, does the system allow them to indicate their hearing loss or the hearing loss of a family member attending the appointment? Will it allow them to request specific equipment usage if any is needed? Will the system allow them to request an interpreter? Will it allow them to then request a specific type of interpreter such as an ASL interpreter, PSE interpreter, SEE sign interpreter, CUED SPEECH interpreter, Mexican Sign Language interpreter, etc.? 
     

  2. Is a system in place to help deaf individuals communicate when navigating parking and security?
     

  3. Is a system in place to help deaf individuals communicate with the information desk if they need assistance?
     

  4. Is a system in place to help the deaf understand the intake information at Reception (and "it's self explanatory" doesn't count as an answer)?
     

  5. How will deaf individuals communicate with reception, particularly if they have any questions? 
     

  6. What systems are in place to ensure communication with the doctors and nurses in the exam/testing/treatment rooms? Is the Wi-Fi strong enough and available for them to use so they can use communication devices such as speech-to-text apps or if you choose VRI (Video Relay Interpreting) is it strong enough to cleanly connect to the VRI equipment? 
     

  7. How will they be able to communicate with the on site pharmacy if needed?
     

  8. Do the systems in place encourage patient independence and autonomy? 
     

  9. If a patient is Deaf/Blind (also written DeafBlind or Deaf-Blind), is there a  system in place for the patient's to read information in braille? 

Order and Onboard All Needed Technology

Common technology needed for smooth communication

Information Apps & Sites
Apps where information is inputted should include questions allowing people to indicate their hearing status and communication requirements.

For example:

Services are needed for someone who is:
O Deaf / Hard of Hearing
O Deafblind
 
The need is for: 
O Myself 
O Child
O Family member

Please communicate with me through
O Voice
O Text 
O Video Relay Service

I require ____________ for communication assistance:
O ASL Interpreter
O PSE Interpreter
O SEE Sign Interpreter
O Cued Speech Interpreter
O Speech to Text App
O Captioning 
O I don't need assistance with communication

I prefer using a ______________ interpreter
O Male
O Female
O No Preference
 
Explanation Videos
1. It's a great idea to have a signed video explaining the intake process. 
2. It's a great idea to have explanation videos signed on your office website.

Curious what one of these videos looks like? Check out an example below:
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Translation/Interpreting Devices

It's a great idea to have an iPad or rolling Video Interpreting system or similar device dedicated solely to communication with Deaf/HH patients & families. Some rolling VRI systems use dedicated software. Other devices can add or remove software. You want to make sure you have devices which can translate voice-to-text. Understand all automated translation services struggle to capture medical terminology. Using voice to text can be very ineffective if complicated medical concepts are being discussed. It can leave questions about informed consent as well, as the patient could possibly misunderstand what was being said.  For Deaf individuals who need or prefer sign language for communication VRI Services (Video Relay Interpreting services) are handy when live interpreters are not available. Only 48% of Deaf people surveyed by the NIH felt VRI services were satisfactory. The service is convenient, but it's difficult to see a small video particularly when in a bed. It's also hard for sign language interpreters to see signs from a distance through a camera. *Note* poor Wi-Fi will effect all these services above. See the videos below to find out more about this service. 

 

NAD Position Statement on the use of VRI services in medical settings

A comedic look at using VRI

Build a Contact Base!

Prepare Your Contacts! It's critical for every medical office to have contacts for sign language interpreters. We strongly discourage offices from using distance agencies or multi-language agencies. Those agencies often provide mediocre interpreters, and the interpreters often do not show to appointments. The screening process is usually minimal, and their prices tend to be high. Local brick-and-mortar agencies are usually the best. If your area does not have agencies, finding private local sign language interpreters is an option. When no live interpreters are available. Online interpreters are an option. (see below).

PREPARE YOUR STAFF

Deaf Community Training

Training can be a tremendous help in preparing your staff for working with Deaf/HH/DeafBlind patients. A simple 2 hour training can completely change the experience your office will have when working with the Greater Deaf Community. 

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TRAINING TOPICS: 

- Technology use

- Tips on interacting with the Greater Deaf Community

- Sign Language basics

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Need training for your office? Feel free to contact Gate Communications! We offer private training in live and remote settings!

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GET CREATIVE WITH DEAF SENSITIVITY TRAINING

See what one hospital did to help their staff understand the "Deaf Experience"

WELCOME DEAF PATIENTS

"If you build it, they will come"

You have spent time preparing your office. If you want to bring in Deaf patients, you can easily by advertising to the Deaf Community via local agencies and social media.

TIPS IN WORKING WITH DEAF/HARD OF HEARING PATIENTS

  1. ​Always speak directly to the patient. Never say "Tell him" or "Tell her."​

  2. Ask the patient, for the record, how they prefer to refer to themselves, d/Deaf, Hard of Hearing, Hearing Impaired, etc. 

  3. If you wear a mask, wear a clear mask (see the LINKS page for an available Level 1/Level 3 product). Facial expressions are critical for D/HH communication. Seeing your face will build respect and trust. 

  4. Try to obtain gender equivalent interpreters when possible. Particularly if a male interpreter was sent to a woman's annual exam, ask the patient if they feel comfortable with a male interpreter or if they would like to re-schedule. 

  5. If using an interpreter, be sure to have the interpreter wait outside while the patient is changing into a gown. 

  6. Position the interpreter near you so a patient can see you and the interpreter in a single glance. During exams, interpreters should never be positioned where they are invading a patient's privacy (ie: during a breast exam the interpreter positions themselves near the shoulder so everything being examined is out of the line of sight.)

  7. Use visuals whenever possible to show the patient their issue, rather than just verbally describe their issue. (ie: Show a graphic of a heart and indicate which valve has a problem rather than just saying "the Tricuspid valve.")

  8. If you are using a sign language interpreter, spell medical and pharmaceutical terms for the interpreter. It avoids the interpreter guessing. It's not a bad idea to write the name of conditions and meds and show the D/HH patient. 

  9. Avoid private conversations with the interpreter in the exam room. Make that time about your D/HH patient. If you are curious how that interpreter became involved with sign language, or if you have any concerns about your patient's comprehension of the subject matter (particularly with foreign patients), have those conversations outside of the exam room.

  10. If an interpreter appears to not understand the patient, make note of that. It's possible the patient is very difficult to understand. There might be a reason for that that is critical to your case, such as a stroke. It's possible the patient is foreign and uses an alternative form of communication. It's also possible your interpreter is not an ideal fit for that particular job. You might need a Deaf Interpreter (a native speaker to assist between the patient and the Hearing Interpreter) or it's possible the interpreter is just not qualified for that job. Some Deaf individuals are difficult to understand because they sign incredibly fast and lazy, some because they are not native ASL users, and some because they have a medical condition prohibiting fluid communication. Whatever the situation if there seems to be an issue, address it. 

  11. When you re-enter a room, most D/HH individuals are unable to hear a knock at the door. If that is the case and there is no interpreter in the room to indicate a knock, ask the D/HH patient how they would prefer you enter the room. Should you just knock, slightly open the door and flash a light, come straight in, etc. 

  12. Try to avoid having conversations with patients while staring at your clipboard. D/HH patients want to see your face and much is missed when looking down at a clipboard.

  13. Speak at a normal pace in a normal manner. Don't over exaggerate your mouth movements. 

  14. With some patients who are oral Deaf, particularly the elderly, and don't use an interpreter, giving a patient a stethoscope then talking into the chest piece can help. This is would not be well received by your standard D/HH patients. 

  15. Never leave an interpreter in the room alone with a patient without the door cracked. 

  16. Never expect an interpreter to keep an eye on a patient. Their job is communication not after care. Dangerous things can and have happened beyond an interpreter's training and responsibility. 

  17. ​Instead of asking "Do you have any questions for me?" ask "Can I clarify any of this for you even more so you have a full understanding of what we discussed?" Many times D/HH individuals won't ask questions, but they still need clarification because they aren't completely clear on the description. It's a great idea to ask, "Would you like for me to write any of this down for you?" That allows the D/HH patient to take the information away and research it or ask for clarification on their own. 

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