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Communication Access In Mental Health And Substance Use Treatment Facilities For Deaf American Sign Language Users.
Tyler G James1, Michael S Argenyi2, Donna L Guardino3
1Tyler G. James (jamesty@umich.edu), University of Michigan, Ann Arbor, Michigan.
Health Affairs (Project Hope)
|October 3, 2022
Summary
Many deaf and hard of hearing (DHH) individuals face communication barriers in mental health care. A significant percentage of facilities receiving public funds were noncompliant with the Affordable Care Act (ACA) in 2019, failing to provide necessary sign language services.
Area of Science:
- Public Health
- Health Services Research
- Health Equity
Background:
- Deaf and hard of hearing (DHH) individuals experience significant mental health disparities.
- Limited empirical data exists on communication access for DHH American Sign Language (ASL) users in mental health and substance use treatment.
- Section 1557 of the Affordable Care Act (ACA) mandates effective communication access in healthcare facilities receiving federal funds.
Purpose of the Study:
- To assess the compliance of mental health and substance use treatment facilities with ACA Section 1557 regarding communication access for DHH patients.
- To quantify the noncompliance rates in providing sign language services to DHH individuals.
- To identify state-level disparities in compliance and propose actionable recommendations.
Main Methods:
- Utilized nationally representative data from the Substance Abuse and Mental Health Services Administration (SAMHSA).
- Analyzed facility reports from 2019 on the provision of sign language services.
- Mapped state-level noncompliance data.
Main Results:
- In 2019, 41% of mental health facilities receiving public funds did not provide sign language services, violating ACA mandates.
- In 2019, 59% of substance use treatment facilities receiving public funds did not provide sign language services, violating ACA mandates.
- Significant state-level variations in noncompliance were observed.
Conclusions:
- A substantial number of publicly funded mental health and substance use facilities were noncompliant with ACA Section 1557 in 2019.
- Urgent policy, facility, and provider-level interventions are needed to improve communication access for DHH ASL users.
- Recommendations include enhanced monitoring, expanded telehealth and licensure reciprocity, systematic needs assessment, and workforce development for DHH ASL-fluent providers.
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