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This interdisciplinary scoping review addresses the involvement of spoken and signed language interpreters in statutory mental health assessments. Specifically, this inquiry seeks to identify and review pre-existing literature concerning the barriers to and facilitators of effective practice in interpreter-mediated statutory mental health assessments, and the extent to which interpreter mediation supports or impedes a person's legal rights and best interests in this context. An interdisciplinary team applied the revised Joanna Briggs Institute scoping review framework to review 44 items, including empirical and grey literature covering relevant aspects of the available body of knowledge across the fields of social work, mental health, and interpreting studies. The review concludes that there is a lack of direct evidence on interpreting practice in the context of statutory mental health assessments, which is significant considering the high-stakes scenarios that may lead to the deprivation of liberty. The findings suggest that there is insufficient evidence regarding necessary modifications to standard interpreting practices for such assessments, as well as how assessors should adapt their own practice in response to the need for interpreting. This work highlights the need for more focused research on good practices for interpreting within this context and calls for guidance to facilitate effective interprofessional collaboration between interpreters and other professionals engaged in these assessments. [ABSTRACT FROM AUTHOR]

This article explores the application of Critical Discourse Analytic methods learnt during a (Social Work) Master’s degree, in the author’s first year of practice as a newly qualified social worker. The focus is the Liberty Protection Safeguards and how the discourse analytic techniques utilised may be translated into specific practice learning. An extract from the author’s Critical Discourse Analysis of the Liberty Protection Safeguards factsheets is presented before further exploration of analytic methods in the context of both literature and personal practice reflections. Specifically, the four issues addressed are: A. Considering how language signals a certain (ethical, social, political, moral) position. B. How language helps construct and reconstruct practice. C. What it means for social work practice to remain open to the consequences of language. D. Considering writing as a form of social work practice. Discourse analytic methods may complement social work values, considering the ethical stance that underpins our work. It is argued that critical discourse analytic tools and the learning arising from them can have a direct influence on social work practice through encouraging practitioners to remain open to language and questioning of the role of power in communication. [ABSTRACT FROM AUTHOR]

Abstract\nPoints of InterestThe Covid-19 pandemic changed the structures of communication, interaction and daily life for everyone. In this study, we examine what those changed social circumstances revealed to deaf young people about their identity, opportunities, strengths and vulnerabilities. Forty-six deaf young people aged 16–19 during the pandemic were interviewed by either deaf co-inquirers or academic researchers with a strong background in working with deaf people. Data were analysed using reflexive thematic analysis. Findings demonstrate that the mental health challenges of the times were not new to many participants but rather just more of the familiar experiences of limited contact with others. However, the circumstances spotlighted attributes deaf people had which had been hidden previously to others including resilience, digital skills and creativity. Improved educational access through digital media was positive eventually but required some self-advocacy to achieve parity.Deaf young people entered lockdown already familiar with limited social contacts, fragile communication and experiences of isolation.Deaf young people discovered new facets of different kinds of deaf identity during the pandemic.There were gains for some deaf young people during the pandemic, including more accessible learning.Skills and abilities that had been unrecognised by others could flourish during the pandemic.Deaf young people entered lockdown already familiar with limited social contacts, fragile communication and experiences of isolation.Deaf young people discovered new facets of different kinds of deaf identity during the pandemic.There were gains for some deaf young people during the pandemic, including more accessible learning.Skills and abilities that had been unrecognised by others could flourish during the pandemic. [ABSTRACT FROM AUTHOR]

Variations in political participation are linked to demographic factors, socioeconomic disparities, and cultural-ethnic diversity. Existing research has primarily explored reduced political involvement among individuals with disabilities, particularly in electoral politics. However, little research has attended the involvement of deaf people specifically. This is of interest because deaf youth are at an intersection of disability, language and cultural identity with their language affiliations and rejection or acceptance of disability evolving through childhood. This study draws from original data collected via an online survey, comprising 163 deaf young respondents aged 16-19 in Great Britain. We compare their levels of political participation with those of general population peers to explore how sociodemographic factors, alongside variations in self-identification as deaf, and meaningful interactions with other deaf people contribute to explain their political engagement. The results challenge conventional wisdom by demonstrating that deaf youth participate more actively in politics than their hearing peers in various forms of political involvement, including collective, contact, and institutional activism. We also recognize differences among deaf youth and propose that social aspects of identity formation, particularly embracing a deaf identity and having deaf friends, can boost certain forms of political engagement. In summary, this study underscores the importance of acknowledging the diversity of deaf youth in terms of affiliation with various forms of deaf identity, rendering their experience different from both disabled and hearing youth. By identifying the factors driving heightened political participation, policymakers and advocates can develop strategies to enhance political engagement among all young people, regardless of their hearing status. [ABSTRACT FROM AUTHOR]

Summary: This article concerns interpreter-mediated Mental Health Act (MHA) (1983) assessments where either a signed or spoken language interpreter is required. It reports data from 132 Approved Mental Health Professionals (AMHPs) in England who have direct experience of such circumstances addressing expertise, training, readiness, and potential influences on the outcome when interpreters are involved. Quantitative data were collected by means of an online survey analyzed descriptively with additional open-ended qualitative responses analyzed thematically. Findings: More interpreter-mediated MHA assessments were reported as occurring in hospital than in community settings. Although AMHPs were confident in their expertise, nearly two-thirds felt they were less effective when an interpreter was involved. The vast majority had received only minimal training on how to work with an interpreter. Recording of language and interpreter use in the assessment was revealed as inconsistent. Most AMHPs thought incorrectly that interpreters were subject to mandatory registration with assured minimum standards of qualification and expertise. Practical problems associated with the timeliness of access to interpreters and complexities of using telephone interpreters instead of face to face were raised. AMHPs expressed a wish for more training and guidance including expectations of the interpreter role. Applications: Consistent standards of formal recording of interpreter use as part of annual monitoring of the MHA are required to understand any potential inequities of outcome resulting from language mediation. Joint training with interpreters is desirable with more specific guidance and resources for working AMHPs and interpreters to promote best practice. [ABSTRACT FROM AUTHOR]

This study concerns culturally Deaf signers in the UK who use hearing aids and (i) explores motivations for hearing aid use (ii) identifies barriers and facilitators to accessing NHS hearing aid services, (iii) examines cultural competency of hearing aid clinics and (iv) identifies factors influencing effective adult hearing aid service provision. Online survey in British Sign Language and English that was informed by Deaf service users. 75 Deaf adult BSL users who wear hearing aids and use NHS hearing aid clinics. No specific reason emerged as outstandingly important for hearing aid use; however, assisting with lipreading (57%) and listening to music (52%) were rated as very/extremely important. Access issues reported were contacting clinics, poor communication with staff and lack of Deaf awareness. To be an effective and culturally competent hearing aid clinic for Deaf signers, a good understanding of Deaf culture and language was most rated as important (87%). The study is the first that explores hearing aid use and experiences of accessing hearing aid clinics from Deaf signers' perspectives. Enhancements to clinical practice are required to consider culturally Deaf people's motivations for hearing aid use and make services more BSL-friendly. [ABSTRACT FROM AUTHOR]

This paper concerns parenting assessments which are integral to child-safeguarding professional processes in England, and which involve Deaf parents whose primary language is British Sign Language (BSL). In an under-researched area of social work, the research aim was to contribute to the existing literature by eliciting the practice wisdom of specialist professionals. Specifically, it draws upon their linguistic and cultural knowledge of the Deaf community when they are involved in parenting assessments with Deaf parents who are subject to safeguarding concerns. Data about these professionals' actual experiences of navigating Deaf cultural-competency in contemporary child protection practices were collected through seven video-recorded, semi-structured interviews conducted in BSL. Using interpretive phenomenological analysis, data were analysed in their source language (BSL). This article focusses on one key theme, termed 'Professional Recognition', which incorporates a) the identification of specialist roles and b) the impact of referral processes and protocols on assessment outcomes. The findings highlight participants' perspectives on the benefits and disadvantages of their specialist role in this context. Although their brokerage skills, cultural competence, linguistic fluency and specialist knowledge of the Deaf community are highly regarded and valued by some colleagues, there is insufficient recognition of their existence by the majority. Secondly, participants are concerned by the inefficiency and inconsistency of the referral processes and protocols which they consider have adverse effects on assessment outcomes, and consequently the parents involved. [ABSTRACT FROM AUTHOR]

Background: This study identified and explored how National Health Service (NHS) hearing aid clinics address cultural competence concerning Deaf British Sign Language (BSL) users. This was approached by (i) investigating how organisational processes meet the needs of Deaf signers from a hospital and hearing aid clinic perspective, (ii) analysing policies and guidelines to investigate if they equip practitioners to meet the needs of Deaf signers and (iii) exploring with practitioners who work in hearing aid clinics about their experiences of working with Deaf signers. Methods: This study utilised a mixed-methods multiple case study design, incorporating documentary analysis and semi-structured interviews. Interview analysis was conducted using Reflexive Thematic Analysis (RTA). The research encompassed two hearing aid clinics in separate hospitals, producing 19 documents and eight interviews (four at each site) with audiologists ensuring a representative mix of professional experience levels. Results: Four themes emerged from the integrated analysis: (1) Understanding Deaf signers; (2) Communicating with Deaf signers; (3) Barriers and Facilitators and (4) Service improvement. A noticeable gap in understanding BSL as both a language and a cultural system was apparent across various policies, strategies, training programmes and staff expertise. Over-reliance on interpreters provided a false sense of accessibility and most participants felt tentative to engage directly with Deaf signers. Positive practices observed at Sites A and B encompassed accurate identification of patients as Deaf signers, improved interpreter availability, communication methods, enhanced training and the encouragement of professional self-awareness. Conclusion: This is the first study that explores cultural competence of hearing aid clinics and its staff concerning Deaf signers in the UK. The results show both clinics require development to become an effective provider for culturally Deaf signers. Examples of how to design culturally competent practices have been provided to assist hearing aid clinics. The findings may be applicable to other underrepresented groups who are not typical users of conventional, acoustic hearing aids provided by the NHS. [ABSTRACT FROM AUTHOR]

This study concerns deaf children under six years in the South African HI HOPES Cohort. To examine their audiological profile, aetiological risk factors for infant hearing loss as well as the relationship between identification, amplification and socio-economic influences. Using a cohort design, secondary data analysis of a pre-existing dataset demonstrated adequate representation of South African demographic characteristics. A total of 532 deaf and hard-of-hearing infants enrolled in the HI HOPES early intervention programme in three provinces (2006–2011). The median age of identification of children with bilateral hearing loss (n = 502) was 24.0 months (IQR = 12–36 months). Infants with aetiological risk factors were identified later than those without risk factors, and the latest age of identification (28.5 months) was for those with three aetiological risk factors (n = 42). The median age of amplification was 32 months with 102 children eligible for amplification at 31.1 months still unamplified. Early identification did not imply early amplification, and the more economically advantaged a Province the smaller the gap between ages of identification and amplification. In a field with little population-level evidence, the size, and representativeness of this dataset makes a significant contribution to our understanding of infant hearing loss in South Africa. [ABSTRACT FROM AUTHOR]

To explore the lived experiences of culturally Deaf British Sign Language (BSL) users who access adult hearing aid services. Semi-structured qualitative interviews were conducted in BSL by the Deaf researcher and analysed using an Interpretative Phenomenological Analysis (IPA) approach. Eight Deaf BSL expert informants who were experienced users of NHS adult hearing aid clinics. Participants expressed dissatisfaction about audiology staff's lack of Deaf awareness and did not feel valued as Deaf signers. Participants' motivations for hearing aid use primarily concerned audibility rather than speech. Mismatch of perspectives on 'hearing' between audiologists and Deaf patients are discussed in the context of culturally sensitive services. Inadequate or uncertain linguistic access during appointments is considered in light of patient agency. This is the first study to explore culturally Deaf signers' specific experiences of adult hearing aid services in the UK and their experiences of hearing aids. There are numerous reasons why Deaf signers wear hearing aids, but access to spoken language is not a priority. Limited Deaf awareness and cultural competence in adult hearing aid services can result in patient frustration and disempowerment. Suggestions for improvement in the Deaf signing patient experience are offered. [ABSTRACT FROM AUTHOR]

This article concerns online data capture using survey methods when the target population(s) comprise not just of several different language-using groups, but additionally populations who may be multilingual and whose total language repertoires are commonly employed in meaning-making practices—commonly referred to as translanguaging. It addresses whether current online data capture survey methods adequately respond to such population characteristics and demonstrates a worked example of how we adapted one electronic data capture software platform (REDCap) to present participants with not just multilingual but translanguaging engagement routes that also encompassed multimodal linguistic access in auditory, orthographic, and visual media. The study population comprised deaf young people. We share the technical (coding) adaptations made and discuss the relevance of our work for other linguistic populations. [ABSTRACT FROM AUTHOR]

In this article, we discuss deaf and hard of hearing (DHH) children's pragmatic difficulties and strengths from within the lived experiences of 5 hearing parents of DHH children and 5 DHH adults (one of whom is also a parent of a deaf child). We define lived experience as both a specific form of knowledge (first-hand stories from everyday life) and a unique way of knowing (reflecting and telling from insider perspectives). The parents and DHH adults involved coauthored the article alongside 2 experienced researcher-practitioners. Key themes include what pragmatic challenges feel like for a DHH person, why they arise, how they might result in longer-term consequences (such as implications for well-being) that can continue into adulthood, what might be pragmatic strengths in this population, and what might be done to ameliorate pragmatic difficulties. We end the article with reflections on the significance of individual parents and DHH adults in the coproduction and execution of research on this topic and make suggestions for future directions of inquiry. [ABSTRACT FROM AUTHOR]

Although major strides have been made in supporting the linguistic development of deaf and hard of hearing (DHH) children, a high risk of pragmatic delay persists and often goes unrecognized. Pragmatic development (the growing sensitivity to one's communication partner when producing and comprehending language in context) is fundamental to children's social-cognitive development and to their well-being. We review the reasons why DHH children are vulnerable to pragmatic developmental challenges and the potential to create positive change. In this call to action, we then urge (1) medical providers to recognize the need to monitor for risk of pragmatic difficulty and to refer for timely intervention (beginning in infancy), (2) allied health professionals involved in supporting DHH children to incorporate development of pragmatic abilities into their work and to foster awareness among caregivers, and (3) the research community to deepen our understanding of pragmatics in DHH children with investigations that include pragmatics and with longitudinal studies that chart the paths to positive outcomes while respecting the diversity of this population. By working together, there is substantial potential to make rapid progress in lifting developmental outcomes for DHH children. [ABSTRACT FROM AUTHOR]

Although life-story work is an established form of support for people with dementia and their carers, culturally Deaf people who are sign language users have been excluded from this practice. There is no evidence base for the cultural coherence of this approach with Deaf people who sign, nor any prior investigation of the linguistic and cultural adaptation that might be required for life-story work to be effective for sign language users with dementia. Given the lack of empirical work, this conceptual thematic literature review approaches the topic by first investigating the significance of storytelling practices amongst Deaf communities across the lifespan before using the findings to draw out key implications for the development of life-story work with culturally Deaf people who experience dementia and their formal and informal carers (whether Deaf or hearing). The reviewed work is presented in three themes: (a) the cultural positioning of self and others, (b) learning to be Deaf and (c) resistance narratives and narratives of resistance. The article concludes that life-story work has the potential to build on lifelong storying practices by Deaf people, the functions of which have included the (re)forming of cultural identity, the combating of ontological insecurity, knowledge transmission, the resistance of false identity attribution, and the celebration of language and culture. [ABSTRACT FROM AUTHOR]

Greece is 6 years into a socio-economic crisis, during which oppression has increased as a result of unjust austerity measures. Reflecting on the need for an anti-oppressive practice, a qualitative study of pre-qualifying social work education was carried out in one of the four national Departments of Social Work (subsequently abolished). This article reports the findings of semi-structured interviews with final year students (n = 14) and academic staff members (n = 10) on the content and context of social work education in relation to anti-oppressive practice. The study revealed the need for a radical shift in social work education based on the emancipatory values of the profession. [ABSTRACT FROM AUTHOR]

This article addresses the impact on occupational relations of mediated communication through a sign language interpreter from the perspective of hearing people who do not sign but who work alongside deaf signers in the workplace. Based on a phenomenological analysis of eight semi-structured interviews, findings address the influence of phonocentrism on working practice between deaf and hearing people. In particular, the implications of the inscription of identity and presence through an embodied language are discussed. The consequences of failure to acknowledge the interpreter as a contingent practice for all, not just the deaf person, are examined. The findings have implications for the recognition and promotion of deaf agency and talent in the 'hearing' work place and extend understandings of structural influences on workplace discriminations to include those of interpreted communication. [ABSTRACT FROM AUTHOR]

The article examines sustainability, equality, and sign language in terms of the journeys of parents and families to construct, deconstruct, and discover meanings through their experience of having a deaf child. Topics covered include the visual orientation of sign language peoples, the ease of communication between deaf people using different signed languages, and raising children in a language other than one's own in Western cultures.

Using selected, contemporaneous illustrations from the reflective journal of a doctoral student undertaking data analysis for the first time, this article examines the relationship between journaling as a learning process when undertaking computer-assisted qualitative data analysis and establishing quality and validity in interpretative phenomenological analysis. The writing of the journal is shown both to enact some potential validity criteria (e.g. in producing an audit trail) whilst also recording and reflectively prompting the process of learning, interpretation and bracketing, thus evidencing transparency. By using a journal inside the software package and alongside the stages of the interpretative phenomenological analysis, analysis within the software package, it is argued that quality and validity become dynamic, not static constructs. These constructs are intimately linked to the researcher-learning-process and permit a critical stance to be taken. [ABSTRACT FROM AUTHOR]

The suicide rate in India (15.84) currently exceeds the global average (11.23) making suicide a significant public health concern. Although suicides in India are debated on medico-legal, socio-cultural, economic and political fronts, the help that is offered to people during times of crisis, before and after the attempt is very minimal. The paper aims to explore support mechanisms from the perspectives of 15 survivors, eight mental health professionals and seven traditional healers in south India. The data were analysed thematically and explored using Bourdieu’s theoretical concepts. Data indicated medical intervention as a prominent method with reservations towards psychological therapies. Reliance upon religious and traditional healing systems was culturally accepted source of support. The social and cultural power experienced by service users and service providers demonstrated a potential to influence behaviours, attitudes, decisions, approaches to services and strategies for support. [ABSTRACT FROM PUBLISHER]

Background: Internationally, few clinical trials have involved Deaf people who use a signed language and none have involved BSL (British Sign Language) users. Appropriate terminology in BSL for key concepts in clinical trials that are relevant to recruitment and participant information materials, to support informed consent, do not exist. Barriers to conceptual understanding of trial participation and sources of misunderstanding relevant to the Deaf community are undocumented.Methods: A qualitative, community participatory exploration of trial terminology including conceptual understanding of 'randomisation', 'trial', 'informed choice' and 'consent' was facilitated in BSL involving 19 participants in five focus groups. Data were video-recorded and analysed in source language (BSL) using a phenomenological approach.Results and Discussion: Six necessary conditions for developing trial information to support comprehension were identified. These included: developing appropriate expressions and terminology from a community basis, rather than testing out previously derived translations from a different language; paying attention to language-specific features which support best means of expression (in the case of BSL expectations of specificity, verb directionality, handshape); bilingual influences on comprehension; deliberate orientation of information to avoid misunderstanding not just to promote accessibility; sensitivity to barriers to discussion about intelligibility of information that are cultural and social in origin, rather than linguistic; the importance of using contemporary language-in-use, rather than jargon-free or plain language, to support meaningful understanding.Conclusions: The study reinforces the ethical imperative to ensure trial participants who are Deaf are provided with optimum resources to understand the implications of participation and to make an informed choice. Results are relevant to the development of trial information in other signed languages as well as in spoken/written languages when participants' language use is different from the dominant language of the country. [ABSTRACT FROM AUTHOR]

This study concerns older Deaf sign language users in the UK. Its aim was to explore how to enable effective information access and promote awareness and understanding of dementia from a culturally Deaf perspective. A purposive sample of 26 Deaf people without dementia participated in one of three focus groups facilitated directly in British Sign Language (BSL) without an intermediate interpreter. The sample was differentiated by age, role in the Deaf community, and diversity of educational attainment and professional experience. A phenomenological approach underpinned the thematic analysis of data. The findings demonstrate: (i) translation into (BSL) is a necessary but not sufficient condition to support understanding. Attention to culturally preferred means of engagement with information is vital; (ii) the content of information is best presented utilising structures and formats which cohere with Deaf people's visual cognitive strengths; and (iii) the importance of cultural values and cultural practices in raising awareness and building understanding of dementia. These include collective rather than individual responsibility for knowledge transfer and the pannational nature of knowledge transfer among Deaf people(s). The discussion demonstrates how these specific features of effective information access and awareness building have universal implications relevant to public engagement and the promotion of general knowledge consistent with the National Dementia Strategy (England). [ABSTRACT FROM AUTHOR]

Objective: This paper explores parental experiences of choices surrounding auditory management and language and communication development for infants and children with auditory neuropathy spectrum disorder (ANSD) in the light of the heterogeneity of condition, a poor evidence base for best outcomes in relation to management options, and the scarcity of data rooted in parent and family experience. Design: Qualitative narrative study. Study sample: Twenty-five parents of 21 children (aged four months to six years) identified with ANSD through the newborn hearing screening programme. Results: Families identify barriers to early management due to conflicting expert opinions and ANSD-specific challenges with diagnosis and prognosis in infants, and share their accounts on their own evaluations of intervention benefit in their children. Conclusions: The results are of relevance to the clinicians and other professionals involved in early intervention, management, and support of infants with ANSD. [ABSTRACT FROM AUTHOR]

This article concerns a study that examines the attitudes of parents, who have had babies in neonatal care, to sharing their babies’ routinely collected health data for research purposes. A participatory methodology was applied to the design of the study; a group of eleven parents who had all previously had babies in neonatal care were involved in designing a large-scale questionnaire survey. The article addresses the rationale for taking this approach, highlighting how it differs from the more common models of patient and public involvement. It presents the five themes that emerged from parents’ discussion in the course of engaging in the questionnaire design: legitimation, expertise, experiential knowledge, a different epistemology, power and control. How these shaped the design of the survey is employed in this article as a means of providing a commentary on the participatory research process itself. The article concludes by reflecting on whether participatory research can achieve its aims of promoting social justice when used for instrumental purposes such as the refinement of a data collection tool. [ABSTRACT FROM AUTHOR]

This article concerns Deaf people in the United Kingdom, who use sign language, who have a formal diagnosis of dementia and who have participated in interviews in British Sign Language (BSL) about their experience of living with dementia. We address the methodological challenges involved in enabling culturally meaningful participation in circumstances where the non-verbal is not equivalent to the non-linguistic. We demonstrate the use of interpretative narrative representation of data for purposes of cultural brokering. We explore the contribution of Deaf people's experiences and the analysis of their visual, spatial narratives to debates about personhood and the embodied self in dementia studies. Finally, we consider the significance of the situational as cultural in relation to holistic interpretation of narrative. [ABSTRACT FROM AUTHOR]

Background: Deaf signing populations face inequality in both access to health services and health outcomes. Telemedicine intervention might offer a potential solution to address these inequalities in mental health and health related services, therefore a systematic review was carried out. The review question was: "What is the efficacy and effectiveness of telemedicine intervention for Deaf signing populations in comparison to face-to-face interventions?". Methods: The PICO framework was applied to identify the components of the review question for this study. The inclusion criteria were: Deaf signing populations; any intervention that includes the delivery of telemedicine therapy and/or the delivery of assessment (e.g. psychological assessments) using telemedicine; and any evidence for the benefits, efficacy and effectiveness of telemedicine intervention with Deaf people whether in health and/or mental health services. The databases PsycINFO, PubMed, Web of Science, CINAHL, and Medline were searched up to August 2021. Results: Following the search strategy, and after the duplicates were removed, 247 records were identified. Following screening, 232 were removed as they did not meet the inclusion criteria. The remaining 15 full-text articles were assessed for eligibility. Only two met the criteria to be included in the review (both concerned telemedicine and mental health interventions). However, they did not fully answer the review's research question. Therefore, the evidence gap remains regarding the effectiveness of telemedicine intervention for Deaf people. Conclusions: The review has identified a gap in the knowledge on the efficacy and effectiveness of telemedicine intervention for Deaf people when compared with face-to-face interventions. [ABSTRACT FROM AUTHOR]

This study addresses the design requirements and innovative data collection methods for a study that aimed to be deaf-centred and child-friendly. The approach was created for a 6-year longitudinal study of Sign Bilingual education from the perspective of eight deaf children who were educated using that approach from 9/10 to 15/16 years old. The research question was: 'From the deaf child's perspective, what are the experiences, advantages and disadvantages of Sign Bilingual education?' This study will discuss the methods developed for the first element of the study when the children were 9/10 years old, using six interactive weekly workshops. These included video diaries, photography, peer interviewing, drawing, poster making and group discussion. The appropriateness for and adaptations made with respect to signing deaf children are discussed as well as the wider significance of this approach for children's research in general. [ABSTRACT FROM AUTHOR]

The article discusses a qualitative study which is nested with a randomized controlled trial to explore experiences of trial participant's of enhanced speech and language therapy after stroke. The participants are those who were diagnosed by aphasia, dysarthria after stroke and participants of the ACT NoW study. The article reveals the result that keeping the patient engaged in deliberate activities in the early months after stroke had effective impact on mood and confidence of the patient.

Over recent years in the UK there has been growing interest in the potential for routinely collected NHS (National Health Service) patient data to be used for secondary purposes, facilitated by the potential of increasingly sophisticated electronic databases. This article is based on a critically reflective literature review which analyses the key debates pertaining to this issue. The work arose in the context of a programme of research concerning routine patient data use in neonatal care. The article includes analysis of commentary (opinion and ethical inquiry) as well as empirically derived claims. It aims to deconstruct the knowledge assumptions on which relevant research studies have been based or are proposed and it also incorporates ontological position and moral argument. Results are presented according to three predominant debates: the prevailing claim that all health research benefits civic society; the varieties of informed consent and choices open to patients regarding secondary uses of their data; and the ‘rights and responsibilities’ of patients when it comes to their data being used for research purposes. It examines the relevance of these themes specifically to the neonatal context and the implications for our own research, concluding that employing an alternative ethical model to the traditional professional one might be useful in order to provide a further perspective on the issue. [ABSTRACT FROM PUBLISHER]

Objective: This paper presents an insight into the parental experiences of how parents made sense of having their child identified with auditory neuropathy spectrum disorder (ANSD), given the broader context of their child's other health issues. Design: Qualitative narrative study. Study sample: Twenty-one families participated whose children had been identified with ANSD through the newborn hearing screening programme. Results: The majority of parents in the sample were overwhelmed with perinatal health issues and initially gave the diagnosis of ANSD very low priority. Conclusions: An understanding of parents' perspective is particularly relevant to everyone involved in early support and management of infants with ANSD. [ABSTRACT FROM AUTHOR]

Early Support (ES) is the flagship government programme aimed at improving multi-agency working with, and supporting enhanced outcomes for, children with a disability 0–3 years and their families. This paper draws on results from the recently completed Department for Education and Skills commissioned national evaluation of ES involving 46 pathfinder projects throughout England. Data were collected by survey at two points in time (9 months apart), by focus groups with service providers and parents, and through secondary data analyses, including exploratory economic evaluation. This paper outlines some of the key findings pertaining to the relationship between integrated children's services and the impact of ES. As such, we address three concerns: what the evidence from ES can tell us about the relationships between universal and targeted provision within integrated children's service structures, the relationship between specific short-term initiatives and their longer-term sustainability within integrated children's services structures and the potential costs and benefits of ES looking forward to its implementation on a national basis within an integrated children's services environment. Although focused primarily on children with a disability in the early years, implications will be drawn for the implementation of Lead Professional Guidance and the Common Assessment Framework more generically. [ABSTRACT FROM AUTHOR]

• Summary: This article reports the findings of the Edge of Change Project which sought to enable specialist social services teams in three local authorities to improve services for Deaf and hard of hearing service users in line with the Best Practice Standards. In particular we highlight the characteristics of the three areas: the projects they chose; a flavour of how they addressed the projects; and identify potential lessons for those similarly seeking to improve services. • Findings: In particular we identify potential glimpses for meaningful change including: change being based on underpinning values, partnership with service users, effective communication, 'seed money' creativity and a collegial style of management. The inhibitors of change identified include: 'keeping the day-job going', underestimating the amount of time and resources required, staff changes, lack of technological support, and the need to be both looking in and out and the fact that external events can change everything. • Applications: The themes discussed are potentially generalizable and may be of help to those considering similar changes with specialist teams. [ABSTRACT FROM AUTHOR]

This article presents data from a study undertaken as part of the national evaluation of the introduction of the newborn hearing screening programme (NHSP) in England. It considers the impact on Education and Social Services of NHSP from the perspective of how each agency perceives each other's role in circumstances where NHSP is requiring a greater focus on interagency and interprofessional working. The qualitative interview study involved 27 education and 15 social services respondents from phase 1 NHSP sites. It reveals considerable agreement on the poorly developed nature of joint working but considerable disagreement about the roots of such. Education is more likely to focus on issues of role, value and skills; social services on conflicts of ethos and culture. The problem of social services' capacity to respond to referrals concerning deaf children was common to both. The findings are placed in the context of government guidance, in particular Early Support and Children's Trusts, both of which support a strategic and statutory basis for interprofessional working in this context. [ABSTRACT FROM AUTHOR]

This article presents results from qualitative interviews with 27 education services working as the lead agency with deaf children and families in sites where the universal newborn hearing screening programme (NHSP) is being piloted in England. This segment of data focuses specifically on how the social work role and practice is perceived by teachers of the deaf. It demonstrates the difficulties encountered in multi-agency working in the absence of specialist deaf child social workers: the perceived impact of deaf child referrals not satisfactorily fitting within any consistent organizational structure within social services; the poor liaison between education and social services over newly identified deaf children; the effects of parental information based on a limited understanding of the social work role and duties. The findings are set within current government initiatives to improve multi-agency working with disabled children and deaf children under three. [ABSTRACT FROM AUTHOR]

In this article, the authors explore the role that characteristics and circumstances attendant on the object of an evaluation might play in the choice of epistemological framework underpinning research design. They consider examples from the consumer-focused evaluation of the introduction of universal newborn hearing screening in England. In particular, they look at how screen- and program-specific issues exerted influence at the levels of epistemology and method, arguing that these choices are not simply a product of values and questions that underpinned one kind of approach to knowledge production in comparison with another. [ABSTRACT FROM AUTHOR]

This paper presents the results from a national study of forensic referrals to the UK's three specialist psychiatric services for deaf people who are users of sign language. A search of 5,034 referrals identified 431 relevant cases. From these, data were collected on patient characteristics, offending behaviour, court disposal and diagnosis. In addition, data were used to estimate the need for a specialist forensic deaf service in the UK. The results show a steady and continuing rise in forensic referrals from the mid-1980s. They contradict previously held assumptions about the late age of first conviction and about the reluctance of the courts to impose probation supervision on deaf people. They confirm and expand our understanding of the high proportion of sexual and violent offences in this clinical population. Nearly 50% of the sample were found on assessment not to be suffering from a mental disorder - a category that excludes patients diagnosed with personality disorder. Figures from the past 30 years and from the past 5 years only are consistent in demonstrating that around 60% of this group would have benefited from a specialist forensic deaf service at some time in the assessment/treatment process. [ABSTRACT FROM AUTHOR]

In this article, a research study that examined the working relationships between Deaf and hearing professionals in health and educational services in the United Kingdom is addressed. These service providers worked in bilingual organizations where both British Sign Language and English were used and in which Deaf people's identity as a cultural-linguistic minority was accepted. The focus of this article is on issues of validity and epistemology that arose for the Deaf and hearing research team in the course of this study. In particular, it examines the influence of identity attributions on the research process for researchers operating within a context of historical oppression, minority language use and legitimization of research knowledge, and challenges to the interpretative analysis used in the study that arose from the dynamics of majority-minority power relations in the wider social world. [ABSTRACT FROM AUTHOR]

In this paper the term Deaf is used of a group of people who use sign language, who come into contact with the criminal justice system in the UK, and for whom mental health needs are associated with their offending behaviour. It critically reviews the existing literature regarding evidence of the prevalence and characteristics of this group drawing on a range of contexts: prisons, high-security services, specialist mental health services, and the police and courts. Particular attention is paid to the relationship between deafness, sign language use, mental disorder and unfitness to plead. Also, consideration is given to the extent to which a limited range of linguistically appropriate disposals for Deaf mentally disordered offenders may account for their twelve-times-higher prevalence in the high-security population than in the general population. Finally, the clinical characteristics of this population are discussed in relation to a range of psycho-social consequences of Deafness and sign language use in the UK today. [ABSTRACT FROM AUTHOR]

Objectives: (i) To identify peer reviewed publications reporting the mental and/or physical health outcomes of Deaf adults who are sign language users and to synthesise evidence; (ii) If data available, to analyse how the health of the adult Deaf population compares to that of the general population; (iii) to evaluate the quality of evidence in the identified publications; (iv) to identify limitations of the current evidence base and suggest directions for future research. Design: Systematic review. Data sources: Medline, Embase, PsychINFO, and Web of Science. Eligibility criteria for selecting studies: The inclusion criteria were Deaf adult populations who used a signed language, all study types, including methods-focused papers which also contain results in relation to health outcomes of Deaf signing populations. Full-text articles, published in peer-review journals were searched up to 13th June 2023, published in English or a signed language such as ASL (American Sign Language). Data extraction: Supported by the Rayyan systematic review software, two authors independently reviewed identified publications at each screening stage (primary and secondary). A third reviewer was consulted to settle any disagreements. Comprehensive data extraction included research design, study sample, methodology, findings, and a quality assessment. Results: Of the 35 included studies, the majority (25 out of 35) concerned mental health outcomes. The findings from this review highlighted the inequalities in health and mental health outcomes for Deaf signing populations in comparison with the general population, gaps in the range of conditions studied in relation to Deaf people, and the poor quality of available data. Conclusions: Population sample definition and consistency of standards of reporting of health outcomes for Deaf people who use sign language should be improved. Further research on health outcomes not previously reported is needed to gain better understanding of Deaf people's state of health. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to situate developmental language disorder (DLD) within the impairment and disability framework of the International Classification of Functioning, Disability, and Health (ICF); describe the functional strengths and weaknesses of a cohort of first-grade children with DLD and their peers; and explore the ways that language-related disabilities relate to language impairment, developmental risk, and receipt of language services. Method: We queried the caregivers of 35 children with DLD and 44 peers with typical language development about their children’s language-related functions, developmental risks, and language services using mixed quantitative and qualitative methods. Results: The children with DLD presented with weaknesses in domains that are highly dependent upon language skill, including communication, community function, interpersonal relationships, and academics. They presented with strengths in domestic and personal aspects of daily living, play and coping aspects of socialization, and gross motor function. Caregivers of children with DLD expressed pride in their children’s agentive and prosocial qualities. Consistent with the ICF, what distinguished children with DLD who had functional weaknesses and disabilities from those who had healthy function was not the severity of language impairment as measured by decontextualized tests of language skill, but the presence of cumulative developmental risks. Compared to those with healthy function, a larger portion of children with weaknesses and disabilities were receiving language services; however, two girls who had disabilities despite mild levels of impairment were without services. Conclusions: Children with DLD present with predictable strengths and weaknesses in everyday language-related functioning. For some children, the weaknesses are mild, but for others, they limit function to a greater extent and should be considered disabilities. The severity of language impairment is not a strong indicator of language-related function and, therefore, is not a good metric for determining service qualification. [ABSTRACT FROM AUTHOR]

This article reports results from a qualitative study in the UK of people with aphasia who have been involved in volunteering. The study describes their experiences; explores, from their perspective, the effects of involvement; and identifies key facilitators and barriers to the successful participation of people with aphasia in community activity. Data were collected by means of 10 individual semi-structured interviews using supported conversation techniques and through a focus group involving five more people. All participants had aphasia following a stroke. Average length of time since stroke for participants in the individual interviews was 5.6 years (range 3-12 years) and for participants in the focus group was 4.6 (range 1-10 years). Results are discussed according to four themes: (i) the effects of the activity on self; (ii) the effects on others; (iii) the effects on organisations hosting the activity and (iv) perceived barriers and facilitators impacting on volunteering. Implications are drawn for the promotion of participatory community activity within the matrix of therapeutic approaches and considered in light of previous studies that have reported the conceptualisations of people with aphasia about their lives and aspirations. [ABSTRACT FROM AUTHOR]

As well as evaluating the newborn hearing screen itself, the government-funded evaluation of the implementation of a Newborn Hearing Screening Programme (NHSP) in England is assessing the impact of the screen on follow-up services. In the UK context, these are principally paediatric audiology, education, and social services. This article presents results from a mixed method research study involving paediatric audiology services specifically. Results demonstrate significant variety in current practice with regard to routine tests and procedures, considerable variability in number of current referrals and time allocated to caseloads, and considerable variability in expectations of how the numbers will change following newborn screening implementation. The challenges of and opportunities afforded by NHSP which were identified by respondents, highlight the urgent need for further training. The study has implications for paediatric audiology services that are yet to start NHSP in the UK, as well as for services and professionals in other countries. [ABSTRACT FROM AUTHOR]

This article offers a critical examination of the conceptual basis of service user involvement through the analysis of a practice example derived from the Deal community. The Deaf community is located both socio-culturally and historically. Findings: One authority's attempts to consult with their own Deaf community is used as the lens to examine the issues, dilemmas and contradictions inherent in consultation and how consultation can be seen as a mechanism both for social control and for empowerment. Applications: The authors identify some of the lessons for practice and argue against the uncritical acceptance of consultation. They identify preconditions for consultation to be beneficial both for the Deaf community and for those wishing to consult with that community. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to describe emergent approaches to integrated care for older people with complex care needs and investigate the viability of measuring integrated care. Methods. A case study approach was used. Sites were recruited following discussion with senior staff in health and social care agencies. Service arrangements were categorised using a framework developed by the researchers. To investigate joint working within the sites, the development model for integrated care was adapted and administered to the manager of each service. Data were collected in 2018. Results. Six case study sites were recruited illustrating adult social care services partnerships in services for older people with home care providers, mental health and community nursing services. Most were established in 2018. Service arrangements were characterised by joint assessment and informal face-to-face discussions between staff. The development of an infrastructure to promote partnership working was evident between adult social care and each of the other services and most developed with home care providers. There was little evidence of a sequential approach to the development of integrated working practices. Conclusion. Components of partnerships promoting integrated care have been highlighted and understanding of the complexity of measuring integrated care enhanced. Means of information sharing and work force development require further consideration. [ABSTRACT FROM AUTHOR]

This article concerns safeguarding deaf children and is written by a dedicated multidisciplinary consortium of national organisations, service providers and academics in the UK. Data are derived from 81 senior managers in social care, health, education, the police and voluntary sector organisations who attended a specialist conference concerning deaf children and safeguarding and who participated in three structured workshops. Thematic content analyses revealed their perspectives on risks and barriers to safeguarding deaf children at practice and organisational levels. An impact/effort matrix structure was used to elicit from participants a series of actions to improve practice and these were thematically organised. Findings are discussed in the context of the 2018 revisions to ‘Working Together’ in England, statutory reforms to PHSE in schools in England and recent NICE revised guidance on Child Maltreatment. Implications for practice are highlighted. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of a conversation on open-ended dialogical approach which preceded the 2014 International Conference on Sign Language, Sustainable Development and Equal Opportunities. Topics covered include the perspectives on sign language in Sub-Saharan Africa, the struggling reading skills of children who are deaf and hard of hearing and the requirements of an inclusive education.

Background: The PHQ-9 and the GAD-7 assess depression and anxiety respectively. There are standardised, reliability-tested versions in BSL (British Sign Language) that are used with Deaf users of the IAPT service. The aim of this study is to determine their appropriate clinical cut-offs when used with Deaf people who sign and to examine the operating characteristics for PHQ-9 BSL and GAD-7 BSL with a clinical Deaf population. Methods: Two datasets were compared: (i) dataset (n = 502) from a specialist IAPT service for Deaf people; and (ii) dataset (n = 85) from our existing study of Deaf people who self-reported having no mental health difficulties. Parameter estimates, with the precision of AUC value, sensitivity, specificity, positive predicted value (ppv) and negative predicted value (npv), were carried out to provide the details of the clinical cut-offs. Three statistical choices were included: Maximising (Youden: maximising sensitivity + specificity), Equalising (Sensitivity = Specificity) and Prioritising treatment (False Negative twice as bad as False Positive). Standard measures (as defined by IAPT) were applied to examine caseness, recovery, reliable change and reliable recovery for the first dataset. Results: The clinical cut-offs for PHQ-9 BSL and GAD-7 BSL are 8 and 6 respectively. This compares with the original English version cut-offs in the hearing population of 10 and 8 respectively. The three different statistical choices for calculating clinical cut-offs all showed a lower clinical cut-off for the Deaf population with respect to the PHQ-9 BSL and GAD-7 BSL with the exception of the Maximising criteria when used with the PHQ-9 BSL. Applying the new clinical cut-offs, the percentage of Deaf BSL IAPT service users showing reliable recovery is 54.0 % compared to 63.7 % using the cut-off scores used for English speaking hearing people. These compare favourably with national IAPT data for the general population. Conclusions: The correct clinical cut-offs for the PHQ-9 BSL and GAD-7 BSL enable meaningful measures of clinical effectiveness and facilitate appropriate access to treatment when required. [ABSTRACT FROM AUTHOR]

Purpose: To translate the health questionnaire EuroQol EQ-5D-5L into British Sign Language (BSL), to test its reliability with the signing Deaf population of BSL users in the UK and to validate its psychometric properties.Methods: The EQ-5D-5L BSL was developed following the international standard for translation required by EuroQol, with additional agreed features appropriate to a visual language. Data collection used an online platform to view the signed (BSL) version of the tests. The psychometric testing included content validity, assessed by interviewing a small sample of Deaf people. Reliability was tested by internal consistency of the items and test-retest, and convergent validity was assessed by determining how well EQ-5D-5L BSL correlates with CORE-10 BSL and CORE-6D BSL.Results: The psychometric properties of the EQ-5D-5L BSL are good, indicating that it can be used to measure health status in the Deaf signing population in the UK. Convergent validity between EQ-5D-5L BSL and CORE-10 BSL and CORE-6D BSL is consistent, demonstrating that the BSL version of EQ-5D-5L is a good measure of the health status of an individual. The test-retest reliability of EQ-5D-5L BSL, for each dimension of health, was shown to have Cohen's kappa values of 0.47-0.61; these were in the range of moderate to good and were therefore acceptable.Conclusions: This is the first time EQ-5D-5L has been translated into a signed language for use with Deaf people and is a significant step forward towards conducting studies of health status and cost-effectiveness in this population. [ABSTRACT FROM AUTHOR]