Interviewing Individuals with Physical Disabilities and Diseases

Presented byCarri, Katie, Katrin, and Lola

• People with Vision Impairments • People with Terminal Illnesses

 • People with Drug Addictions

 • People who are Deaf

Vision Impairments

  • The definition of "legally blind" is 20/200 with correction

 • Most people who are considered "blind" have some sight

rather than no sight at all.  • Visual impairments are ususally considered more of an

inconvenience than a disability.  • While many people who are blind can read Braille, most do

not. • There are an estimated 10 million blind and visually impaired

people in the United States, 1.3 million of which are considered legally blind

  Vision impairments can affect people from every culture, age and background. Most commonly you will be interviewing visually impaired people who are: • Elderly • Autistic • Those with a mental condition • Those with a physical disability that affects their vision • Veterans • Blind from birth • Those who are recently blind or visually impaired because of

trauma or illness • Those who culturally don’t make eye contact

  • Over 65% of what is gathered from a conversation is

collected by observing non-verbal cues.  • Those with visual impairments may be missing out on over

35% of communication cues like: o  facial expressions o  gestures o  head nods

 • Different techniques must be used to create comfort, show

trust  and create clarity.

Here are some things to think about before the interview: • Do you have background detail about your client’s ability?

 • Are you prepared to offer a longer session of time?

 • Do you have (or can you get) your confidentiality and general

agency forms transcribed?  • Be prepared to use physical contact to guide.

 • Physical contact will last longer.

 • Can you meet them in their setting?

 • If in an office setting, be prepared to go out to lobby and

meet them.

  • Ask about their condition and how they are usually

accommodated. They know themselves the best.  • Mention your nerves or naivety in accommodating visually

impaired people.  • ALWAYS ASK FOR PERMISSION TO GUIDE!

 • Guide them to their chair.

 • Go over forms together.

 • Never interact with a guide dog when on duty.

  More tips!

• Describe your setting  • Describe EVERYTHING you are doing.

 • Describe it from their point of view.

 • Don’t describe things by color/size. Descriptions must be

relational.   • Don’t move things! Keep the set up of the room consistent.

  More tips!

• Check in with the individual every 15 minutes or so.  • Direct your voice. Address your speaking directly to them,

not away.  • Be aware of client’s comfort through unique body cues.

 • Avoid pausing without speech for too long or moving without

     speaking.  • Use your voice appropriately.

 • Describe any things that are affecting your voice.

 • Always announce when you leave the room.

People with Terminal Illnesses

• Terminally Ill - signifies a person has a prognosis of 6 or less months to live

 •  Some common illnesses that are or can become terminal:

o Cancers (Pancreatic, Lung, Leukemia...) o Chronic heart & lung conditions o Kidney failures o Alzheimers and other forms of Dementia o Lou Gehrig's disease/ ALS (neuromuscular disease) o AIDS

 • Services available:

o hospital care, hospice care, counseling   

• In your personal lives

• Via social groups (church, clubs...)

• With clients who are nearing death

• To relate to clients whose loved ones are dying  

• Client's cultural views toward death and dying  • Condition of person you are going to interact with

• It is ESSENTIAL that you understand the certainty of your own death

 • Address any fears you have about death or talking to a

dying person.  • Ask yourself...

o What are you personal values on life and death? 

o What are your cultural beliefs on death? How could they affect your professional practice?

 o How would the death of a client of yours affect you?

• Physical Attending:o Get on their level physically

on your knees on a chair

o  Get close are they hard of hearing?

o Show physical care through touch hold hands, touch

shoulder o Focused Listeningo Make eye contact

 • Let the individual know they

are attractive and loveable  • What are they not saying?

Can this be a clue to an issue in their dying process?

• Find a way to accept a dying person as a living person, just like yourself, rather than an "other" who is very different and object-like because they are dying (Public Affairs Television, 2000).

 • Chaplain's tip for empathy - Imagine the dying individual as

a young, healthy, child with no wrinkles or scratches  • Non-verbal empathy (physical attending)

 • Let go of your personal distractions

 • Be sensitive to their pain, but give attention to the PERSON

  • Are you comfortable talking about your illness/condition?

• What does your condition feel like?

• What gives you comfort at this time? (respecting integrity of patient; practices beneficence)

 • Life Review - Questions about their life. Have they already

had experiences with death in their life?  • Questions about "trivial things" can lead to more substantial

conversation

• Be careful not to say "you are going to get better." • Avoid using the words "death" or "dying" etc. around the

person. Rather, use euphemisms like "passing" or "passed on" (M. Lodge, Personal communication, February 13, 2009).

 • When meeting only once, do not ask about life regrets and

dark experiences - Keep things in the positive realm 

More specifically to alcohol and harder drugs

• No single treatment is appropriate for all individuals• Treatment needs to be readily available 

 • Effective treatment needs to attend to multiple needs of the

individual, not just his or her drug use • Remaining in treatment for an adequate period of time is

critical for recovery- this is usually around 3 months, but depends on the type of drug

 Agonist Maintenance

Narcotic Antagonist

Outpatient

Long or short term Residential

Medical Detoxification

Prison-based Programs

Are meant to supplement and enhance treatment programs. They have all been

supported by research through the National Institute on Drug Abuse (NIDA).

Basic Principles:1. Express empathy2. Develop discrepancy3. Avoid argumentation4. Roll with resistance5. Support self-efficacy

Phase I: Build motivation for change

Phase II: Strengthen commitment to change

Follow-through Stresses importance of using a significant other (SO) in the process, this works especially well for marijuana addicts & alcoholics.

The Counselor should:• High level of empathy• Interpersonal warmth • Ask open-ended questions• Use reflective listening• Roll with resistance • Support client perception

that change is possible & can be accomplished

Avoid:• Confrontation/denial trap• Expert role• Closed/short answer

questions• Don't label client

• Teaches behavior modification

• Collaborative, action-oriented therapy

• Behavioral experiments• Role-play exercises • Skills training• Brief time period therefore

relapse is highly possible• Inappropriate for those with

cognitive disabilities (depending on level of functioning)

Counselors should:• Focus on current situation

& solution• Change views & beliefs

about life• Give control to client

 Counselors should avoid:• Overdependence• Focusing on the past• Changing client personality

traits

• Cognitive-behavioral • Learning processes play

critical role in development of maladaptive behavioral patterns

• Learn to identify & correct problematic behaviors

• Enhance self-control5 primary components:1. Assessment2. Warning sign ID3. Warning sign management4. Recovery Planning5. Relapse intervention training

Counselors should:• Enter into collaborative

relationship with client• Supportive & directive

approach• Point out self-defeating ways

of thinking/acting while advoacting basic integrity of client

• Very directive in establishing agenda & maintaining procedures

Counselors should avoid:• Projecting problems on

clients that they don't have• Avoid harsh confrontation

To be Deaf mean to partially or wholly lacking or deprived of the sense of hearing ; to be unable to hear (2009, Defining Deaf

Culture).

General information

• Most people who are deaf do not consider themselves to have a disability

• Hearing Aids do not completely solve the problem

• Be aware of social norms within deaf culture

• ASL IS NOT A UNIVERSAL LANGUAGE

General tips when Interviewing

• I conduct the interview in a well lit area if the client is lip reading

• Ask how to client would prefer to communicate during the interview

• Speak in a normal tone with a normal seed of speech

• Treat everyone with respect

Interviewing with an Interpreter

• obtain a interpreter that specializes in a particular subject if needed.

• Position the interpreter next to the interviewer

• Eye contact with the client

• Speak directly to the deaf or heard of hearing person.

Interviewing without anInterpreter

• Provide a written copy of the interview question

• Use a lot of gestures and facial expressions

• Maintain eye contact with client

• Be prepared to rephrase questions if necessary

• Do NOT always rely on note taking or just speech reading

• DO NOT speak directly to the interpreter

• DO NOT assume the client is struggling because they are Deaf

• DO NOT assume anything about any client

• Hearing Health Clinico 2940 Squalicum Parkway, Bellingham WA.

• Bellingham Hearing Center Incorporatedo 303 Potter Street, Bellingham WA

• Hearing Speech and Deafness Centero 114 West Magnolia Street-Suite 316

 • General interviewing skills

o respect of the persono empathyo listeningo attending

 • Client has power in how to discuss their illness or disability

 • Supporting the individual and their needs

 • Owning your mistakes as interviewer

Commonly used Signs

About ASL. (2009). ASL info. Retrieved February 10, 2009, from http://www.aslinfo.com/aboutasl.cfm/ http://www.aslinfo.com/aboutasl.cfm/

About us. (2009) Hearing speech and deafness center. Retrieved February 10, 2009, from http://www.hsdc.org/aboutus/

American Foundation for the Blind. (2009). Living with vision loss. Retrieved on February 19, 2009, from http://www.afb.org/Section.asp?SectionID=40

ASL info. Retrieved February 22, 2009, from http://www.aslinfo.com/hints.cfm/

Bellingham hearing center incorporated. (n.d.). Welcome to Bellingham Hearing Center. Retrieved February 16, 2009, from http://www.bellhear.com/

Braithwaite, D. O., & Thompson, T. L. (2000). Handbook of communication and people with disabilities: Research and application. Mahwah, NJ: Lawrence Erlbaum Associates.

Defining deaf culture. (2009). What is Deaf culture? Retrieved February 10, 2009, from http://www.deafculture.com/definitions/

Duba, J. D., & Magenta, M. (2008). End-of-life decision making: A preliminary outline for preparing counselors to work with terminally ill individuals. The Family Journal, 16(4), 384-390. Retrieved February 3, 2009 from the EbscoHost Database. 

Feldman, D. B., & Lasher Jr., S. A. (2007). What should I be saying?: Learning to talk with someone who is dying. In The end-of-life handbook: A compassionate guide to connecting with and caring for a dying loved one (pp. 109-125). Oakland, CA: New Harbinger Publications. Florida Division of Blind Services. (2008). A guide to working with persons with who are blind or visually impaired. Retrieved on February 19, 2009, from http://www.myflorida.com/dbs/employer/work_with_blind.php Florida Division of Blind Services. (2008). Basic facts about blindness and visual impairments.Retrieved on February 19, 2009, from http://www.myflorida.com/dbs/employer/basic_facts.php

Ford-Martin, P. (2005). Behavioral therapy health article. Retrieved February 18, 2009, from healthline.comHearing Health Clinic. ( 2008). Hearing loss facts & statistics. Retrieved February 16, 2009, from http://www.hearinghealthclinic.com/facts.html

Hearing Health Clinic. ( 2008). Hearing loss facts & statistics. Retrieved February 16, 2009, from http://www.hearinghealthclinic.com/facts.html

Job Accommodation Network. (2008). Accommodation and compliance series:Employees with vision impairments. Retrieved on February 17, 2009, from http://www.jan.wvu.edu/media/Sight.html

Medical Ethics Advisor, (2008, December). End-of-life discussions with physicians have benefits. Medical Ethics Advisor, 24(12), 141-142. Retrieved February 3, 2009 from the EbscoHost Database.

Miller, W. R. (1995). Motivational enhancement therapy with drug abusers. Retrieved February 16, 2009, from www.motivationalinterview.org/clinical/METDrugAbuse.PDF

Murphy, B. C., & Dillon, C. ( 2008). Interviewing in action in a multicultural world. Belmont, CA: Thomson Brooks/Cole.

National Institute on Drug Abuse. (2000). Approaches to drug abuse counseling. (National Institutes of Health Publication No. 00-4151). Washington, DC: U.S. Government Printing Office.   National Institute on Drug Abuse. (1999). Principles of drug addiction treatment: A research- based guide. (National Institutes of Health Publication No. 00-4180). Washington, DC: U.S. Government Printing Office.

National Technical Institute for the Deaf. (2009). Interviewing a Deaf Person. Retrieved February 20, 2009, from http://www.ntid.rit.edu/nce/emp_interview.php

Public Affairs Television (Producer). (2000). Living with dying [Series episode]. In On our own terms: Moyers on Dying [Video Tape]. Princeton, NJ: Films for the humanities & sciences.

Sardegna, J., & Paul, O. T. (Eds.). (1991). The encyclopedia of blindness and vision impairments. (pp. 2-159). New York: Facts on File. 

Sinick, Daniel. (1976, November). Must dying be deadly?: Counseling the dying and their survivors. Personnel and Guidance Journal, 55(3), 122-123. Retrieved February 3, 2009, from the EbscoHost Database.

Useful tips for working/communicating with someone who is deaf or hard of hearing. (2009). ASL info. Retrieved February 22, 2009, from http://www.aslinfo.com/hints.cfm/