Mental Health Guide

To assist families and professionals in supporting the mental health and developing social skills of children and youth with hearing loss, VOICE has produced “I Feel Good!” A Guide to Support the Mental Health and Well-Being of Children and Youth Who Are deaf and Hard of Hearing in Ontario's schools. This publication was developed in collaboration with the Canadian Hearing Society and with input from researchers at Universities of Toronto and Western Ontario as well as clinical psychologists. 

Click HERE to download the "I Feel Good" Guide.  | French

Section 1: A Message from the Collaborators

“I Feel Good!": A Guide to Support the Mental Health and Well-Being of Children and Youth Who Are Deaf/deaf and Hard of Hearing in Ontario’s Schools” (Guide) was developed collaboratively by VOICE for Hearing Impaired Children and the Canadian Hearing Society. This guide offers a compilation of information, strategies, and resources that promote healthy social and emotional development and is relevant to all adults who are part of the lives of children who are Deaf/deaf or hard of hearing.

This resource, funded by the Ministry of Education[1], is designed to help parents and educators distinguish among problems that are age-related and developmentally appropriate, those related to the impact of a hearing loss[2], and those behaviours that may be indicative of more serious mental health and social/emotional concerns. This guide was developed to complementSupporting Minds: An Educator’s Guide to Promoting Students’ Mental Health and Well-being, a resource developed by the Ministry of Education which provides educators with information on the early signs of mental health and addictions problems, along with strategies that can be used in the classroom to support students. This document can be accessed at http://www.edu.gov.on.ca/eng/document/reports/SupportingMinds.pdf.

It is essential that all children be given the best start in childhood and adolescence in terms of their mental health and well-being. We hope that you find information and resources in this guide to better understand children and the impact of their hearing loss in order to make good decisions that will promote healthy social and emotional development.​

This Guide has been developed to offer proactive and pro-social strategies as well as tools to educators and parents of children who are Deaf/deaf and hard of hearing  who may be experiencing social and/or emotional problems related to their hearing loss. Mental health exists on a continuum and if you have any serious concerns about a child’s mental health, we encourage you to consult with your family doctor and school resource team. In addition, if you would like advice from or referrals to professionals who have experience with students who are Deaf/deaf or hard of hearing, contact VOICE at www.voicefordeafkids.com or the Canadian Hearing Society at www.chs.ca.

Both VOICE and CHS obtained significant support in the researching and writing of the information contained in this document through contributions from researchers in the Childhood Hearing Loss Laboratory at the University of Toronto and the Department of Psychology King's University College at the University of Western Ontario.

[1] The views and opinions expressed in this guide are those of the author(s) and do not necessarily reflect those of the Province, Ministry of Education and its staff.

[2] For the purposes of the 'I Feel Good' guide, the term 'hearing loss' may refer to either a partial or total inability to hear.

Section 2: Guiding Principles

"I Feel Good!": A Guide to Support the Mental Health and Well-Being of Children and Youth Who Are Deaf/deaf and Hard of Hearing in Ontario's Schools (Guide) represents a collaboration between the Canadian Hearing Society and VOICE for Hearing Impaired Children to create a resource for parents, educators and families of children who are Deaf/deaf and hard of hearing, and is funded by the Ministry of Education.
 
This Guide has been designed to increase awareness and understanding of potential social and emotional issues related to being Deaf/deaf or hard of hearing. Some of these issues are interrelated to language development and ability and its effect on healthy social interaction, however this Guide is not intended to instruct parents and professionals in specific techniques that address language acquisition in children who are Deaf/deaf or hard of hearing. The Guide’s focus is on providing tools, strategies and resources that promote mental health and well-being of students who are Deaf/deaf or hard of hearing.
 
The Ministry of Education uses the terminology “children who are Deaf/deaf and hard of hearing” to identify children who have a range of hearing losses. Other terms that are used to address this population include “culturally Deaf, deaf, deafened, hard of hearing, hearing impaired, or oral deaf," and this list is not exhaustive. For clarity, in this Guide the terminology “children who are Deaf/deaf or hard of hearing” will be used to refer to a broad range of children who are using either a spoken language, a signed language, or both, and includes both audiological and cultural perspectives.

Section 3: Guide Instructions

“I Feel Good!”: A Guide to Support the Mental Health and Well-Being of Children and Youth Who Are Deaf and Hard of Hearing in Ontario's Schools is an online resource for parents and professionals supporting children who are Deaf/deaf or hard of hearing at different stages of social and emotional development.​

Each section addresses a different topic and can be read as a stand-alone. The sections do not have to be read in sequence. As such, since each section can be read separately, readers might find that some information is repeated.

The sections have been divided according to developmental stages; if your child is not exhibiting behaviours expected for a certain age, refer to the previous section and focus on reinforcing the development of those skills.

Parents and professionals are encouraged to use this Guide in whatever order is best suited for the children they are supporting.

This Guide is one among many resources available. Throughout the Guide, we have provided links to relevant guides and resources where appropriate.

Section 4: Mental Health & Well-Being Meaning

The World Health Organization defines mental health as, "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community" (WHO, 2007). Rather than focusing on how negative interactions affect mental health, this perspective emphasizes the positive qualities that allow individuals to succeed and thrive in society, many of which involve elements of healthy child and family support systems and the development of strong social and interpersonal communication skills.

Characteristics of Positive Mental Health:

• Courage, optimism, hope, honesty, interpersonal skills, work ethic and perseverance.

• Ability to enjoy life – Living in the moment, appreciating the “now." Ability to learn from the past and plan for the future without dwelling on things that can’t be changed or predicted.

• Resilience – Ability to bounce back from hard times, manage stress without loss of optimism.

• Balance – Ability to juggle many aspects of your life. Ability to make changes to restore balance when necessary.

• Self-actualization – Recognition and development of individual strengths to reach one’s full potential.

• Flexibility – Ability to feel and express a range of emotions. Ability to solve problems and revise expectations.
  

http://mentalhealth.about.com/cs/stressmanagement/a/whatismental.htm

Parents play a very important role in guiding the development of these attributes of positive mental health in their children. Each child (and parent) is unique with their own temperament, personality, strengths and weaknesses and the interactions of these factors with the environment, genetics, and the challenges of life make each parent/child relationship a little bit different. There may not be an absolute recipe for success, but authors such as Paul Tough (“ How Children  Succeed — Grit, Curiosity, and the Hidden Power of Character") outline seven character traits key to children's' success, especially at school:

• Grit

• Curiosity

• Self-control

• Social intelligence

• Zest

• Optimism

• Gratitude

http://www.cbc.ca/news/world/story/2012/11/22/f-how-children-succeed-paul-tough.html

Section 5: Mental Health Disorders and Risk Factors

A differential diagnosis is the term used when identifying the presence of one disorder where there are multiple alternatives possible. This method is essentially the process of obtaining information that identifies the presence of an additional condition aside from the hearing loss. The challenge for the professional is to be familiar with the development of children with hearing loss in order to identify the possibility of other disorders, especially those with a language component (e.g. delays and disorders in speech and language unrelated to hearing loss). When a parent or educator is concerned about the development of the child who is Deaf/deaf or hard of hearing, it is imperative to seek out the knowledge of those professionals who are experienced with this population. Below are some descriptions and symptoms of disorders often showing comorbidity with hearing loss.

Please click HERE for a full list of mental health disorders.

Section 6: The Developing Child

Child development generally refers to the time period between birth and the end of adolescence. This time period is markedly different from any other stage of human development for it encompasses tremendous biological, psychological, social and emotional changes. These developmental changes represent a progression from dependency towards increasing independence, and are marked by the achievement of developmental milestones.

​Developmental milestones are functional skills or age-specific tasks that most children can do within a certain age range. Each milestone that a child reaches is like a building block or stepping-stone fostering the next phase of change. Child development typically progresses through four major skill areas, which are:

1. Language: Expressing needs, wants and thoughts, using body language and gestures, understanding what others say/sign and expressing complex and abstract thought.

2. Movement and muscle coordination: Using the body’s large muscles (sitting, standing, walking, running, keeping balance, and changing positions) as well as small muscles (eating, drawing, playing, dressing, colouring) and developing hand-eye coordination.

3. Play and social: Having relationships with others, cooperating, and responding to the feelings of others.

4. Thinking and reasoning: Learning, understanding, problem-solving and remembering.

Language Development

Language is a very important key to success in the development of mental health of children who are Deaf/deaf or hard of hearing.

Early Language Development (0-3)

The first three years of life are a period of incredible growth in all areas of a baby’s development. Babies’ primary attachment is to their parents and these relationships are the foundation upon which babies build their knowledge of the world. All babies and toddlers need positive early learning experiences to foster their intellectual, language, social and emotional development and lay the foundation for later success.

Early Screening

Every year in Ontario, approximately four in 1,000 babies are born Deaf/deaf or hard of hearing. In addition, some infants or children will lose their hearing in the early years due to infections, high fevers, trauma, and genetic disorders. Many of these children may need to learn speech and language differently, so it is important to detect a hearing loss as early as possible.

Early identification also provides parents with support and information which allows them to educate themselves regarding their child’s needs. It is helpful for parents to meet with professionals, and other families with children who are Deaf/deaf or hard of hearing, who have travelled the same journey.

One of the most crucial decisions parents will make at this time is how their children will develop language. Identifying a hearing loss early ensures that children can get the help they need and the chance to develop language skills comparable to children with typical hearing.

Babies born in Ontario are screened for hearing loss at birth and audiological and language intervention services are available to families though government funded programs. The following link provides more information about screening, child development, language stages and intervention services:

http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/hearing/index.aspx

Family Reactions

Some parents are prepared for the possibility that their baby will have a hearing loss. This may be because members of their family are Deaf/deaf or hard or hearing and/or the baby’s parents are Deaf/deaf or hard of hearing themselves. These parents usually already have some knowledge, supports, and parenting experience. However, approximately 90% of children with a hearing loss are born to parents with typical hearing and, for many, it may be a new experience. Some commonly expressed concerns are:

• How will we communicate?

• How do we parent her?

• How will his brother and sister play with him?

• How will he learn?

• What about her grandparents?

• Will she love us?

• Will he be normal?

• How will we know what to do?
   

A baby who has been identified with a hearing loss is a baby like any other. Babies need love, care, and nurturing in order to develop secure attachments. A secure attachment between a baby and their parent leads to the healthy development of emotions, as well as a better understanding of relationships later in life.

However, there are some important differences in parenting a baby who is Deaf/deaf or hard of hearing. It is not that parents need to do more or less for their child, but will need to do things differently. The following are some recommendations to consider in this early stage of getting to know your baby.

Communicating with their child is one of the most important things parents can do. This, however, can be one of the most difficult challenges facing children who are Deaf/deaf or hard of hearing. Whatever mode of communication parents decide for their baby, spoken or sign language, or what kind of amplification (hearing aids, cochlear implants) is decided, it is very important that the baby learns language from an early age.​

When a baby is born (and even while still in utero), a very specific area of the brain is ready to learn and use language. This highly specialized part of the brain does not particularly care which language is used - it just wants language.

Early language milestones are found in the following link:

http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/hearing/brochure_services.aspx

Section 8: Tools & Strategies for Parents/Teachers

One of the best ways to prepare all children and teens to deal with everyday challenges is to give them the emotional life tools they need to have successful connections with friends and adults in their social circles. Although childhood is thought to be a time of growth and development without the responsibilities of adulthood, it is a period that can carry concerns and anxiety related to social interactions, academics, and athletic accomplishments. Additional challenges, such as a hearing loss, other sensory or learning issues, may further impact the ease and confidence with which a child or teen navigates through life stages.

A strong command of language forms the crucial foundation onto which children and teens build their knowledge of the world and interactions. Social language and skills are naturally learned by children with typical hearing through overhearing, observations, and often with no direct teaching. These skills are naturally developed by children as they observe others and by having other people react to their behaviour. How we learn social skills is based on very subtle cues, such as facial expressions, body postures and quiet auditory cues. Because of their smaller “listening bubbles," children who are Deaf/deaf or hard of hearing do not pick up social language cues and the subtle aspects of interactions going on around them as fully as their peers with typical hearing.

Parents and teachers may wonder whether a child who is Deaf/deaf or hard of hearing is exhibiting typical developmental behaviour in the domains of social skill development, self-esteem, and self-advocacy. Parents and teachers may incorrectly assume that certain observed behaviours are reflections of the consequences of the child being Deaf/deaf or hard of hearing and that children with typical hearing do not demonstrate these behaviours. At times, while the child is in the language acquisition stage, a parent may observe their child’s frustration related to communication attempts. For this reason, it is important for parents and educators to have a solid understanding of typical child development in the area of social skills in order to support the social and emotional development of children who are Deaf/deaf or hard of hearing.

This Guide focuses on supporting the well-being and emotional health of young people with hearing loss. This proactive and preventive approach provides strategies to build their self-esteem, boost confidence, strengthen coping skills, reduce anxiety and build resilience in children and teens that are Deaf/deaf or hard of hearing.

What can teachers do?

• The daily actions of effective teachers and their positive relationships with their students actively promote the appropriate growth and mental health of students.
• Teachers’ roles and relationships reach through and beyond the substance of the curriculum to impact students’ feelings of self-worth, dignity, identity, and belonging. Through interactions with both students and their parents, teachers are in a unique position to strengthen these important elements of mental health.
• Teachers are also in an excellent position to observe mood changes or behaviours that seem excessive or unusual, perhaps lasting longer than average, which could indicate a mental health problem requiring consultation and intervention.
• “Sometimes you just can tell that something is not right.”

How can parents help?

• Parents know their children best, therefore trust yourself when advocating for your child
• Actively engage with your child without overwhelming
• Collaborate with your child’s school
• Have a professional who is Deaf/deaf or hard of hearing on the Individualized Education Program planning team

Section 9: Contributors and Collaborators

VOICE for Hearing Impaired Children was established in the early ’60s by parents to offer support to other families with children who were deaf and hard of hearing. These Toronto parents wanted their children to be educated alongside their hearing peers in mainstream schools. VOICE chapters have spread throughout Ontario, with associate chapters in other parts of Canada. Today, VOICE’s principle objectives include providing hope and support to parents and inform them that children who are deaf or hard of hearing can learn to listen and speak. In particular, VOICE develops and implements programs and services encompassing parent support, public education, advocacy, and auditory-verbal therapy.

For more than 70 years, the Canadian Hearing Society (CHS) has served people who are culturally Deaf, oral deaf, deafened and hard of hearing. CHS has tried to meet the needs of all the communities it serves. As an advocate, CHS has pressed for accessibility in workplaces, health-care and education. As a service provider, the CHS offers a wide range of services and is the largest Canadian provider of services that remove barriers to communication, advance hearing health, and promote equity for people who are culturally Deaf, oral deaf, deafened and hard of hearing.

Both VOICE and CHS would like to acknowledge the tireless efforts of the following individuals who assisted in the creation of this Guide:

• Anita Bernstein, M.Sc. LSLS Cert AVT, Director of Therapy and Training Programs, VOICE for Hearing Impaired Children 

• Cathy Chovaz, Ph.D., Assistant Professor, Department of Psychology, King's University College, at The University of Western Ontario 

• Alice Eriks-Brophy, Ph.D., Graduate Coordinator, Associate Professor, Department of Speech-Language Pathology, University of Toronto

• Rebecca Grundy, MSW., RSW, Program Director, Counselling Services, Canadian Hearing Society​

• Gary Malkowski, M.A., L.H.D., Special Advisor to President, Public Affairs, Canadian Hearing Society

• Barbara O’Dea, Ph.D., Barrier-Free Education Initiatives Project, Canadian Hearing Society

• Rhonda Quesnel, Psychological Associate 

• Leah Radziwon, research assistant, Childhood Hearing Loss Laboratory, University of Toronto

Section 10: Resources

Please click HERE to view a full list of resources.