It’s common knowledge that a child’s first years are critical for language development.
But what if that child is deaf and has parents who don’t know sign language?
Chriz Dally, a board member of the Kansas Association of the Deaf, posed that scenario last month at a meeting of state officials and members of the National Council on Disability.
Between 90 percent and 95 percent of deaf children have hearing parents with no experience with deaf people or American Sign Language (ASL), Dally said. That sets back deaf children academically, compared to their hearing peers, by the time they arrive in school.
“The child is left in a double jeopardy of not having access to language and then not having the support system in place at home to continue language development,” Dally said in written testimony submitted to the council. “So that affects their ability to receive a gainful education. Thus, their life prospects are diminished.”
The solution, Dally said, is to allow Medicaid coverage for ASL therapy for deaf children and ASL training for their parents who don’t otherwise have the resources to learn.
Medicaid currently covers speech therapy for the children, but she said that’s not enough. The key to spurring the cognitive activity inherent in early language learning is “to develop natural communication flow between the child and the parent.”
“Just providing speech therapy alone does not work in helping the child acquire a language,” Dally said. “Speech is not a natural, visual language to the deaf child.”
Sara Belfry, a spokeswoman for the Kansas Department of Health and Environment, said Medicaid already covers ASL therapy when it’s provided through early childhood intervention programs such as Tiny-k and schools.
Petra Horn-Marsh, who teaches elementary education at the Kansas School for the Deaf in Olathe, said that’s not enough.
Horn-Marsh said right now in-home ASL instruction for deaf children and their hearing parents is available only from a few grant-funded instructors, most of them working “less than part-time.”
In contrast, speech-language pathologists who work with tools like hearing aids and cochlear implants to help hard-of-hearing children integrate into the hearing world are reimbursed by Medicaid.
The demand for those services is similar to the demand for in-home ASL therapy, Horn-Marsh said.
“Hence our request that ASL therapy serviced by trained professionals proficient in ASL — native and near-native fluency — be available to deaf and hard-of-hearing infants and children and their families by Medicaid just like speech-language pathology services,” Horn-Marsh said.
Psychotherapy through telemedicine
Advocates for deaf and hard-of-hearing Kansans were happy to hear that Medicaid already provides reimbursements for psychotherapy counseling performed remotely through telemedicine. That could help the Johnson County Mental Health Center fill a major gap in services in other parts of the state.
Deaf Kansans in most of the state have a glaring lack of access to mental health services, Elijah Buchholz and Kim Anderson of Johnson County Mental Health Center told the disability council.
Deaf people are twice as likely to experience trauma, the pair said, yet far less likely than those who can hear to have a mental health provider who can communicate with them.
Johnson County Mental Health Center is the only place in the state that has behavioral health services geared to the deaf community, they said. While the majority of deaf Kansans live in that county, there are significant numbers of deaf Kansans in other counties with no services in their area.
Buchholz and Anderson said the solution to that shortage is to create a Medicaid reimbursement for telehealth services, so deaf people in other parts of the state can access the Johnson County program remotely.
“This will be the most cost-effective manner of delivering culturally competent, linguistically accessible mental health services to the deaf communities of Kansas,” the duo said in written testimony.
Belfry said Medicaid already has a funding mechanism for telemedicine and that it would apply to videoconferences in which Johnson County therapists could communicate directly via sign language with patients in other parts of the state.
Buchholz said he was excited about the possibilities. The next step will be to reach out to other mental health providers and let them know the service is available to their deaf clients, he said.
“It sounds like we do have the capability and there is a funding mechanism,” Buchholz said. “It sounds like we can move forward in creating those partnerships.”
Buchholz and Anderson also suggested to the disability council that the three KanCare companies be required to each have a staff person devoted to deaf member services, to ensure that the needs of deaf clients aren’t overlooked.
They said the companies’ failure to print their member handbooks in ASL was one such oversight.
“Just as the handbook is available in Spanish to the Spanish-speaking community, so should the handbook be available in ASL format to the ASL community,” Buchholz and Anderson wrote.
Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.