Pilot Training - „Intervention with Deaf – Needs in acute crisis situations” - Germany

The Pilot Training about „Intervention with Deaf – Needs in acute crisis situations” took place on the 7th of December 2016 at the Centre for Psychotraumatology in Krefeld. The Training was held with 27 participants working in the field of victim protection in order of the regional authority and experts of hearing impairment.


EUNAD - International Workshop

 "Psychosocial Crisis Management - Assisting People with Visual and Hearing Impairment in Case of Disaster"

The international conference as a part of the EUNAD project on the topic of needs of people with visual and hearing impairment in situations of disaster took place on 30.-31.10.2013 at the Ministry of the Interior under auspices of the minister of the interior and deputy prime minister Martin Pecina. The employees of the Security Policy Section of the Ministry of the Interior and of the Faculty of Arts, Charles University in Prague participated in the organization of the event. 54 specialists in the area of psychosocial assistance and crisis management and experts from the organizations of persons with visual or hearing impairment participated in the conference. The interpreters of the Czech, Danish, German and international sign languages were used during the conference. The conference was held in English. It was a cross-discipline working conference where experts from the academic and research spheres, representatives of police, fire brigade, crisis management, health sector, non-profit private organizations focusing on humanitarian and psychosocial help and organizations of people with hearing or visual impairment got a chance to meet together.

Results

Results of the conference are derived from the conclusions of presentations, results of questionnaire inquiries and conclusions of debates that took place in round tables. The results are aggregated and include information and recommendations concerning both the target groups, i.e. persons with hearing and visual impairment. Among the outcomes of the conference there are also power point presentations of different speakers and other written outcomes published on the web sites www.mvcr.cz/eunad. For those who are interested in these more detailed and complex information we recommend to look for further reading there.

A. Preparedness

A.1 Major gaps (disconnects) between planners, crisis managers, responders and people with hearing or visual disability:

There are gaps in European guidelines regarding older people, persons with disabilities, children and young people, helpers and questions of gender, culture, ethics, catastrophic event types and long term effects of trauma. Future work on special topics on communication, humanitarian assistance centres and identification is needed. In some countries (e.g. Germany), there is no official list of therapists and social care services which are able to communicate in sign language. Also, managers sometime think mainly about the speed of actions during possible disasters and do not realize that when they do not communicate properly, they make the situation worse.

A.2 Specific norms for the employers to create an emergency plan for the employees with disability. Specific trainings for groups with visual or hearing impairment or other disabilities (e.g. in schools, workplaces, communities):

Mostly, there are no specific crisis management plans (norms) in the majority of countries like Croatia and Austria. In Denmark there is only very basic training regarding people with visual impairment. In Hungary, there are special regulations concerning people with disabilities only in the emergency plans of special schools, rehabilitation institutes or institutes for elderly. In the Czech Republic, there are basic trainings for fire fighters about communication with people with a disability, which could be useful for pilot trainings.

A.3 Specific crisis management plans for the transient places (schools, stores, restaurants, trains and others) with respect for the people with hearing/ visual disability:

There are no such plans in most of the participating countries (Denmark, Austria, the Czech Republic - except metro etc.) Mostly, consciousness is much more about people with physical impairment then people with hearing/ visual impairment. In Norway and the Netherlands, new public buildings and some of the private ones are really well built for people with visual impairment.

A.4 Including people with disability in disaster drills, trainings, simulations of first responders:

Disaster drills do not include people with disability in a majority of countries (e.g. Croatia, Denmark, Austria). As an example of good practice, in the Czech Republic, there are exercises every year and every time there is somebody with a disability in the exercise. Some exercises are held in Canada too. In Hungary, there was a training course by trainers from the school for the blind, teaching fire-fighters techniques of orientation for dealing with someone with a visual disability.

A.5 Advantages, disadvantages, and unintended consequences of developing segregated versus unsegregated sheltering systems or evacuation centres:

Disadvantages:

  • People with disability would be separated from their loved ones who do not have any impairment (for example deaf children, which are born to hearing parents)
  • It is not realistic to evacuate them separately, because it is overly complicated
  • Higher costs
  • It is against the model of inclusion
  • Not all staff everywhere would be most likely trained properly

Advantages:

  • Communication might be better tailored to need and accessibility, direction and training of staff could be adapted accordingly to the needs of individuals with special needs.

A.6 Usefulness of a local transportation network which would serve individuals with special needs before, during, and after an emergency or disaster:

Generally, public transportation is not fully adapted for people with hearing impairment by communicating also in the sign language (e. g. the Netherlands, Denmark). People with hearing impairment do not need special separate transportation, they need information, which means fully adapted public transportation networks.

A.7 Other recommendations in relation to preparedness:

An on-call (on-line) service of sign language interpreter should be available in all life situations (currently, service of language interpreter is not accessible well in most of countries).

B. Networking

B.1 Contact and cooperation between the rescue workers and the organisations of people with disabilities. Examples of best practice:

In some countries, there is no cooperation and preparation for crisis (Croatia, Hungary) or the cooperation is only on a theoretical level (the UK). As for others, cooperation is in the beginning and is not systematic. In Germany, there are held first aid courses for blind people. In Denmark, there is a good cooperation between police and the Danish Deaf Association. In Norway, fire and rescue services conduct a project called "fire safety for vulnerable groups", in cooperation with user groups (police, community services), including the topics of preparedness, communication and information. Organizations of people with hearing disability can take responsibility for the training of basics of the signed language for police. A model for cooperation was provided by the Canadian project named 'EnRiCH' which main goal is to design, implement and evaluate resilience-oriented interventions in 5 target communities. See: http://www.enrichproject.ca/

B.2 Efficiency of community based "special needs" registries:

Advantages, disadvantages, and unintended consequences In the USA, small cities have check lists of people with disabilities in order to map their special needs. There are persons responsible for every person with disabilities. In Israel, there are also special needs registries and "neighbourhood emergency teams", which are responsible for notifications of emergency in case of disaster. In the UK, special needs registries exist too. However, although all vulnerable groups are meant to be included, they are more directed toward physical impairment. Advantages of these registries are possibility to train staff according to the needs of individuals with special needs and also the accessibility of the disabled person. Disadvantage of these registries is that they are difficult to maintain because of rapid changes in where people live and changing needs. Also some people do not want to be listed, because they do not want to be labelled - there is a danger of stigmatizing. In the Czech Republic, there were plans to create a map, which would show where people with disabilities are living. It wasn't finished, probably on the basis of law and ethical problems. In Czech towns Písek and Olomouc there are isolated examples of good practice - registers of persons with disabilities (for using an emergency warning SMS). In Olomouc they have a special methodology for support of hearing impaired people in case of emergency. Special registries are not used in Hungary either, because the registration should not differentiate minorities. According to EU Directive - there is the right of all people to have equal access to emergency warning.

C. Communication with visually/hearing impaired people

C.1 Crucial points in the initial moment communication during the first moments of the disaster:

The most important thing in disaster is to save people, of course. Then, according to participating professionals, we can start thinking about the words we are using in communication. Also, special categories are not the priority. However, in aftercare we do need special plans for each group. We have to be aware that some people with hearing impairment do not understand native language (during a tornado in the USA, there was no information for people who did not understand English). Similarly, there is a need of simplification of language used by authorities and awareness that not all people with hearing impairment are able to read. Furthermore, the majority of people with hearing impairment are not able to communicate in the sign language. As for persons with disability, the best source of information is their family. The family should be also used in the communication process with medical and security forces. Sometimes, persons with hearing disability aren't willing to make communication with hearing persons easier and don't want to use for example cards informing about hearing impairment or use a pen and a piece of paper. It is necessary to mention that they also have a responsibility for their safety.

C.2 First response mechanisms in the crisis situation TV:

  • Information given during disasters should always bedescribed also by voice for the benefit of people with visual impairment. Sign language should always be used
  • Conversation manual with signs useful in emergency (this was created in Israel)
  • Large screen with sign language and subtitles (for communication with a group of people)
  • Use of emergency beeper, pager
  • Video messages and video translation
  • Fax, emergency SMS service for hearing impaired to make contact with helping institutions in emergency situations
  • Cards with signs (these are used in Sweden) or electronic patient journals
  • Applications enable to interpret the sign language (e.g. by using Skype)
  • iModus (crisis communication technology)
  • Trygfonden (DK) has recently designed an app that allows individuals to press a button for help using a GPS function
  • Alarms, which can vibrate
  • Radio

C.3 Crisis situations - specific types of disasters - during which the current ways of crisis communication (technical solutions) would be threatened:

It is important to develop tools that aren't based on electricity, internet and mobile phones (some "basic communication questions and tools"). During disaster, it could be helpful to have a pen and a piece of paper ready.

C.4 Specific communication needs for the different groups of people with disabilities (People with prelingual hearing loss, people who lose hearing during their life, persons with partially sighted/ with low vision or people with blindness):

People with a prelingual hearing loss are not able to speak, write and read fluently. They use sign language usually. They can have difficulty in understanding of social situations and abstract concepts.The emphasis is more often placed on these hearing impaired, in contrast to people who lose hearing during their life (who represent majority of cases). Hearing impaired individuals, who are able to use a signed language, need to communicate in it. Lip reading is difficult in a time of crisis and works only for those who have already learned a native language. Writing things down is not optimal for a therapeutic situation.

D. Training

D.1 Crucial points for the training of first responders, psychosocial acute helpers, caregivers during the time the critical situation is in progress, shelter workers, social workers, doctors, psychotherapists in the aftercare, volunteers and other people to support people with sensory impairments in the acute phase as well as in the mid- and long term aftercare:

Trainings have to include people with impairment. Also, basic knowledge of the native sign language of the general population is needed. Regarding trainings, the most important thing is to train disabled persons (as for this topic, e.g. information material for hearing impaired is not available in Germany and possibly other countries as well).

D.2 Usefulness of considering different emergency situations and training for them separately:

On a general basis, different emergency situations should be trained separately (because of a difference in duration and magnitude of particular disasters, different needs in different kinds of situations etc.)

D.3 Actors or lay actors playing people with sensory impairment and other disabilities in exercises:

Including actors in simulated situations was not regarded as a good practice (appeal of people with disability "Nothing about us, without us"). However, some professionals think that it could be useful, because it could improve the empathy and understanding of needs of people with disability in these kinds of situations by emergency workers.

D.4 Recommendation of the form, content and extent of the training (Should it be specifically designed for particular units?):

Trainings should be designed for particular units. Responders should undertake field exercise, community groups could have discussion sessions to include cross section of community and debate about roles and responsibilities during a crisis. As an example of a good practices, there is a methodical DVD about communication with persons with various disabilities during an emergency created by Fire Rescue Service of the Czech Republic. In Israel, fire fighters are required to work for 30 hours with disabled people.

E. Future proposals

E.1 Usefulness and recommendations about wider information campaign among the general public about people with specific needs in crisis and disaster situations:

A good campaign could include better psychological education at school and inclusions in schools. Reddit and You Tube could also be used to reach children. A very good way to inform the general population is to promote communication and interaction between this population and disabled persons and help the general population to experience what it is like to be disabled (as for people with visual impairment, there are specialized restaurants, museums, shopping sessions...) As an example of a good practice, in Germany, there is a flyer from the federal government of Germany about how to be contacted when you are deaf, how to get attention, communicate and the use of simple signs. Over 20,000 of these flyers are distributed. In the future of such campaigns, more variability is needed - people with impairment do not have to be a central message in some sort of campaign, we should focus on more "peripheral" messages.

F. Additional recommendations

F.1 Problems with terms:

There is a term first responder, elsewhere the term zero responder is used (it may be a slang expression referring to non-professionals who help before the arrival of first responders). Then, there is a question of the "special needs" term or other terms we are using (us, them, minority) because it creates differences between people. Also, all needs could be viewed as regular and individualized in each person. Persons with hearing impairment do not like to describe themselves as "disabled". They consider themselves as being a part of a "linguistic and cultural minority group". It is not appropriate to use the term handicapped person or disabled person and similar. The term - person with disability is more suitable. People with disabilities have the same needs during the catastrophes and disasters, as the overall population. The difference is only in the achievement, fulfilment of the needs, which can be specific.

F.2 Question about how effective is therapy with an interpreter present?

There is a need of psychologists who are able to offer a therapy directly in sign language. It is important that the sign language interpreter is not known to the hearing impaired individual. People with hearing impairment would not want a deaf psychologist/therapist because there is a high risk of meeting them in the hearing impaired community.

F.3 There is a syndrome that may explain the issue of the commonality between posttraumatic reactions and some hearing problems ("Tonic tensor tympani syndrome"):

Another link between PTSD and hearing problems could be indicated by the temporo - mandibular joint. There is also a link - deregulated arousal level - between hyperacusis and hyper activation syndrome of PTSD.

F.4 Problem of a comorbidity:

We should focus also on people with both a visual and a hearing impairment. Furthermore, the matter of hearing or sight impairment or impairment of other functions, is related to old age and people with such impairments present prevailing groups! Most of the effects of serious catastrophes show up in older people. A related topic is the communication between a person with hearing impairment and a person with visual impairment.


EUNAD - Local Workshops

Czech Republic - "Psychosocial Crisis Management - Assisting people with hearing impairment"

The local workshop 2 took place in Prague, Czech Republic. An example of good practice in the city of Olomouc was presented. 

Results

There are various information dissemination tactics - sirens, notice boards, media (local radio), short running notices on public traffic stations. For people with hearing impairment there is an SMS Info-channel. People can register to a database and get emergency messages by SMS. There is also communication with organizations of disabled people about seminars and lectures for people with hearing impairment about preparedness for critical accidents. There are activities for children in schools about awareness for special needs of disabled people. Preparedness of police and fire-corps includes people with disabilities. The training preparedness of people with hearing impairment - not much, sometimes lectures as in Olomouc. There is the possibility to register a disability at the integrated rescue service. The organizations are in contact with members - if necessary, they visit them personally or send written messages such as for older people, who do not have internet access or mobile phones. In critical situations, it is complicated to get an interpreter quickly, but there is a possibility of interpretation to sign language via Skype. What is needed - transcription in TV news (signing sometimes available); information campaign for the whole public; something, that indicates, that a person does not hear, such as an info card, a symbol with an ear (there was no agreement between participants). There is not a visual version of the emergency number 112 - the ministry is working on it now.

Denmark - "Hearing impairment and psychosocial intervention"

The one day workshop took place at the University of Southern Denmark, Odense at the 12th June, 2013 with representatives from the emergency/rescue services and mental health professions plus one hearing impaired individual. The focus was on emergency treatment (first aid) and psychosocial aftercare for hearing impaired individuals in the event of disasters/ serious accidents/ crises. The aims were to identify through the sharing of knowledge and experiences: What we currently know about trauma and trauma-related conditions in the hearing impaired population. How do hearing impaired individuals react to disasters/ serious accidents/ crises - what specific needs do they have? How can emergency and mental health professionals best help hearing impaired individuals in the event of disasters/serious accidents/crises?

Results

Challenges associated with booking a sign language interpreter in acute crisis situations and at some hospitals and doctors' surgeries. No procedure for this yet limited office hours at the booking centres and the "acute booking function" is not always working; this may be a question of financing? Lack of political decisions in the field? Video translation is used very rarely; we need to make the most of the technical opportunities that are out there. Only one place in Denmark that specializes in deaf psychiatry Geographical, economic and practical limitations for many hearing impaired individuals. General lack of knowledge about hearing impaired individuals among emergency workers and mental health professionals. Quality training is needed!

Germany (ZfP) - "Hearing impairment and psychosocial intervention"

The local workshop in Germany took place on the 19th of July 2013 at the art'otel in Cologne. 22 representatives of disability associations, universities, rehabilitation and psychosocial professionals participated. The workshop aimed the exchange about national crisis management for visual and hearing impaired people between experts.

Results

1. Needs and support in acute crisis:

Experiences:

  • Focus to be on Deaf using sign language first
  • Always argued that there is not enough need because it is such a small group (minority)
  • How can deaf be recognized?
  • How is the daily life situation? Concept for disaster should be based on that
  • How can acute be defined?
  • As most first responders are helping voluntarily we do not want to overstrain them

Analysis of needs

  • There are three groups of deaf: 1. Little ability to read and write, 2. Ability to read and write, 3. Ability to read, write and speak
  • Special meaning of body contact
  • Use existing structures
  • No lists/information about acute psychosocial intervention for deaf exist
  • Information centres mostly work voluntarily
  • Institutions like fire brigade and BBK are not prepared for deaf people
  • Acute services should be implemented on communal level
  • Cooperation with deaf association, ministers, social workers is necessary
  • Use meetings of the deaf e.g. "Conference of the deaf" to spread information
  • Sign language interpreters have to remain neutral
  • There happen to be a lot of misunderstanding when deaf people using sign language and hearing people with no ability to understand sign language try to interpret the signs

Approaches

  • Training for volunteers, e.g. via "Caritas Düsseldorf"

Technical solutions:

  • Fax, SMS, apps for deaf to call for help and/or to inform them about emergencies
  • Fire brigade is working on a strict routine. Which routine is most necessary and sensible with deaf?
  • Use existing structures
  • Implement an interpreter on-call service.

2. Mid- and long-term psychosocial intervention

Analysis of needs:

  • Information material is missing. Neither printed, nor via media, internet, multipliers, etc.
  • Other opportunities to spread information: "KOFO", "Culture days", schools, "Sehen statt Hören" (TV program), Facebook, VLOGS (Blog)

Services:

  • Does therapy with an interpreter present work?
  • Not enough cooperation with German Deaf association
  • Use existing structures
  • How can services like interpreters be financed? How can we be ensured that deaf will seek after and make use of services from hearing people?
  • Consider possible trauma of the consultants
  • Services which should be considered: integration service (IFD), social service, clinicians, clinical treatment