Publications

Advances in virtual reality (VR) technology have created a wide range of remote work options. The goal of this study was to explore the experiences of individuals with albinism using VR work environments as a reasonable accommodation for remote work. Four cohorts of five participants each worked for 6 months at their leisure in a variety of virtual environments and met monthly with the research team to discuss positive and negative experiences with the technology and accessibility features. Using inductive thematic qualitative analysis, we followed a three-step coding process to identify themes in recorded transcripts of individual interviews and focus group discussions. The participants spent an average of 3.8 hours per week in VR, with an average session lasting 0.85 hours. From the coding analyses conducted by five coders, four themes were developed including the following: difficulties with VR’s limitations, recommendations for improving accessibility in VR, benefits that VR could bring to the workplace, and navigation practice applications for VR. While VR provided improved visual experiences for nearly all participants, there are needed features that could dramatically improve accessibility. Although individuals with low vision can customize many features of VR to optimize their visual experience, many of these accessibility features are specific to applications and not consistent across developers and hardware ecosystems. Despite its shortcomings, VR shows great promise as an accommodation for people with low vision. In particular, individuals participating in the current study found great utility in VR’s ability to assist with navigation of unfamiliar environments and its potential use in the workplace.

Using state-of-the-art techniques, the authors interpreted two commonly used depression inventories, the revised Beck Depression Inventory (BDI-II) and Patient Health Questionnaire–9 (PHQ-9), into American Sign Language (ASL): BDI-II-ASL and PHQ-9-ASL, respectively. A national sample of 361 deaf individuals who preferentially use ASL completed the BDI-II-ASL and PHQ-9-ASL online. BDI-II-ASL and PHQ-9-ASL scores were significantly and positively correlated. The results showed no significant differences in scores due to gender, Deaf cultural identification, race, ethnicity, or employment status. However, the results did show that less education was significantly associated with higher depression scores. The BDI-II-ASL and PHQ-9-ASL require norming in a comparative study of a confirmed diagnostic group and healthy control group.

Limited research has focused on the risk of suicide within the deaf community, and no published studies to date report SBQ-R scores in deaf populations. The purpose of this study was to adapt the Suicide Behaviors Questionnaire-Revised into American Sign Language (SBQ-RASL). After the translation protocol was completed, the SBQ-R-ASL was field-tested with 340 deaf individuals in a national sample. Data analysis indicated satisfactory validity and internal consistency, and a Principal Components Analysis resulted in one factor. Field-test data revealed a mean SBQ-R-ASL score of 8.76, which is above published cutoff scores for suicide risk. These findings demonstrate a crucial need to norm the SBQ-R-ASL for deaf populations.

Background: During the COVID-19 pandemic, telehealth became a widely used method of delivering treatment for substance use disorders (SUD), but its impact upon treatment engagement and dropout remains unknown. Methods: We conducted a retrospective analysis of adult SUD patients (n = 544) between October 2020 and June 2022 among a cohort of treatment-seeking patients at a nonprofit community behavioral health center in Southwestern Ohio. We estimated the likelihood of treatment dropout using survival curves and Cox proportional hazard models, comparing patients who used telehealth with video, telephone, or solely in-person services within the first 14 days of diagnosis. We also compared the likelihood of early treatment engagement. Results: Patients who received services through telehealth with video in the initial 14 days of diagnosis had a lower hazard of dropout, compared to patients receiving solely in-person services (0.64, 95% CI [0.46, 0.90]), while there was no difference in hazards of dropout between patients who received telephone and in-person services. Early use of telehealth, both via video (5.40, 95% CI [1.92, 15.20]) and telephone (2.12, 95% CI [1.05, 4.28]), was associated with greater odds of treatment engagement compared to in-person care. Conclusion: This study adds to the existing literature related to telehealth utilization and engagement in care and supports the inclusion of telehealth in SUD treatment programs for treatment-seeking individuals.

Background: The Brief Addiction Monitor (BAM) was developed as a comprehensive substance use disorder (SUD) outcome metric to fill a gap in quality measurement. Research to date has only examined the psychometric performance of this measure in veteran SUD populations. The purpose of the current research is to examine the factor structure and validity in a non-veteran SUD population. Methods: Non-veteran patients admitted to a SUD treatment program (N = 2,227) completed BAM at intake. Exploratory factor analysis (EFA) was used to assess the factor structure and psychometric properties of the BAM within the full sample and within subgroups, specifically racial, referral source (mandated vs. not), and primary SUD diagnosis. Results: Exploratory factor analyses in the full sample supported a 4-factor model (representing Stressors, Alcohol Use, Risk Factors, and Protective Factors) derived from 13 items. Subsequent EFAs conducted separately in each subgroup revealed variability in the number of resulting factors and pattern matrices. The internal consistency also varied among factors and between subgroups; in general, reliability was greatest for the Alcohol Use scale and either poor or questionable for pattern matrices resulting in scales reflecting Risk or Protective Factors. Conclusion: Findings from our study suggest that the BAM might not be a reliable and valid instrument for all populations. More research is needed to develop and validate tools that are clinically meaningful and allow clinicians to track recovery progress over time. Keywords: substance use disorder, brief addiction monitor, factor analysis

Creating accessible health information (HI) decreases inequities, empowers individuals to make informed health decisions, and promote cues to action for potential health behavior changes. However, HI may not be created with accommodations to allow engagement in HI for some populations, such as indi- viduals with hearing loss. Therefore, developing HI based on specific guidelines such as Universal Design for Learning (UDL) can lend itself useful in HI development. The purpose of this article is to explain UDL guidelines of representation and how they can be incorporated into HI so that it is accessible to a wide audience, including with hearing loss.

The Satisfaction With Life Scale (SWLS) is a brief instrument that assesses a person's global life satisfaction. Using state-of-the-science techniques, the SWLS was translated into American Sign Language (ASL). A national sample of 350 deaf and hard of hearing individuals who preferentially use ASL completed the ASL version of the SWLS (SWLS-ASL) online. The individuals in this sample had a mean SWLS score of 23.4, well within the range of mean scores reported for samples from general populations of hearing individuals. No significant differences were identified in SWLS-ASL scores due to gender, cultural identification (identified as culturally Deaf or not), race, ethnicity, education, or employment status.

Background: This study explores differences between adult suicide rates in counties in Ohio from 2007-2016, specifically differences between urban and rural counties. Nationally, the least densely populated states in the nation have the highest rates of completed suicide, and that same trend was hypothesized to exist in the least densely populated counties in Ohio.

Methods: Simple demographics and rates for sub-populations and counties were retrieved for adults over 18 years of age, and separated by rural and urban counties. A random effects meta-regression model was developed to assess the association among suicide death rate, rate of emergency rooms, rate of mental health providers, rate of social associations, and rural or urban counties.

Results: There were differences in suicide rate between urban and rural counties. Suicide death rates were significantly associated with rate of mental health facilities, rate of social associations, and type of county (e.g., rural versus urban). As the rate of mental health providers increased, there was a significant decrease in the rate of suicide deaths.

Conclusions: This study illustrates the positive effect that access to mental health service providers can have on decreasing suicides in rural areas. More studies are needed focusing on unmet needs in rural areas, specifically those looking at individual level predictors of suicide.

Key Words: Suicide, Population Density, Social Association, Mental Health, and Rural

Telerehabilitation has emerged as a promising option for vocational rehabilitation to address barriers with consumers. Pilot programs like the one described here are being used to remotely train counselors and serve consumers by providing treatment and support through technology. This program delivers training and service through an online portal that allows consumers specific options tailored to individual needs. Counselors have been trained in 43 states via webcasts, videoconferencing, and in-person trainings. Telerehabilitation can enhance employment outcomes by improving access for consumers, strengthening the counselor-consumer relationship, and increasing contacts with consumers. Counselors can also augment traditional services and increase engagement without increasing travel time and associated costs. Consumers are able to take a more active role in the vocational rehabilitation process, have a better understanding of VR services, increase their knowledge about what to expect of VR services, and be more accountable and involved in the progress and outcomes of VR services.

If language is delayed through developmental milestones in childhood, individuals may have less access to the resiliency tools necessary to build social support and positive social identity. Suicide attempts may represent a maladaptive form of communication stemming from delayed ability to express unmet emotional needs. To evaluate the relationship between age of language acquisition and suicidality, analysis was conducted on self-reported data from prelingual deaf adults in substance use disorder treatment. Suicidal ideation was reported by 50.5% of consumers, and lifetime suicide attempts were reported by 42.1%. Individuals with significantly delayed language acquisition presented with the highest rates (61.1%) of suicidal ideation.

This article reports on a National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Disability and Rehabilitation Research Project (DRRP; Federal Grant # 90DP0067). The project is being conducted by investigators in the Substance Abuse Resources and Disability Issues (SARDI) Program in the Boonshoft School of Medicine at Wright State University (WSU), in collaboration with nationally recognized experts on Deaf culture and substance abuse/mental health. The goal of this DRRP is to develop and test an online suite of instruments in American Sign Language (ASL), validated for deaf consumers, assessing substance use, mental health, and occupational interests. The translation process used to validate these assessments in ASL is discussed along with the current project status.

The objective of this research was to explore whether increased exposure to E-Therapy results in more successful therapeutic outcomes for persons with disabilities and substance use disorders (SUD). A Mann-Whitney U test was used to analyze exit interview data on 48 persons who had successfully completed SUD treatment. Clients who received a higher percentage of SUD treatment as E-Therapy had better therapeutic outcomes and those who received fewer therapeutic sessions had less successful outcomes. E-Therapy has critical policy implications and should be promoted as a cost-effective way to provide SUD treatment to persons who are deaf or experience low-incidence disabilities.

Purpose: The purpose of this article is to discuss the upsurge of technology-enhanced rehabilitation education programs and telerehabilitation services, to provide examples of these advancements, and to discuss the implications of this technology for education and the field including the unique advantage to developing technological skills through participation in effective online coursework allowing rehabilitation graduates the requisite transferable skills for competent online service delivery. Method: The authors completed a thorough review of the available literature on online technology-enhanced education programs and online telerehabilitation services. Results: Rehabilitation counselor education and the delivery of rehabilitation services have capitalized on recent technological advancements and provide opportunities to reach students and consumers via the Internet. Conclusion: It is clear that technology-enhanced education and clinical services will have an expanding role in the future of rehabilitation counselor education and practice. There is a unique advantage for students to develop technological skills through participation in effective online coursework. The skills learned from completing online courses are transferable skills for competent online service delivery.

This study was conducted to assess whether an online substance use disorder (SUD) treatment program is an effective way to serve the deaf population with SUD. The outcomes for deaf consumers who receive online SUD treatment from the Deaf Off Drugs and Alcohol (DODA) program were compared to the outcomes for deaf individuals who receive culturally appropriate residential SUD treatment at the Minnesota Chemical Dependency Program for Deaf and Hard of Hearing Individuals (MCDPDHHI) and the California Awakenings Residential Program for the Deaf. The adults were invited to participate in this study before SUD treatment began. A total of 95 deaf persons in treatment for SUD participated in this study: 42 in California (23 men, 28 women), 45 in Minnesota (28 men, 17 women), and 8 in Ohio (6 men, 2 women). SUD treatment outcomes for deaf consumers who received treatment online in the DODA program did not differ from outcomes for deaf consumers in traditional, culturally appropriate inpatient treatment programs. This suggests that the online DODA program may be an effective option to use for some deaf clients.

The Deaf Off Drugs & Alcohol (DODA) Program provides culturally appropriate recovery services via e-therapy to Deaf and hard of hearing (HH) individuals with substance use disorder (SUD). In the first three years DODA was providing services, 149 consumers (107 Deaf, 42 HH) received treatment. A retrospective secondary data analysis sought to examine the lifetime prevalence of suicidal behavior in Deaf individuals receiving alcohol and drug treatment services from the DODA program. The prevalence of self-reported lifetime suicide attempts in the Deaf sample was 42.1%, higher than rates reported for other subgroups with coexisting conditions. Suicidal ideation was reported by 50.5% of Deaf consumers and by 65.1% of Deaf women. Variables significantly associated with suicide attempts included past mental health diagnosis. Possible explanations and future study are discussed.

The study objectives were to adapt and validate a substance use disorder (SUD) screening instrument in American Sign Language (ASL) to be used to identify those deaf individuals who have a high probability of having an SUD. The goal was to develop an accurate screening instrument that balanced sensitivity and specificity while imposing minimal response burden on respondents. Method: A sample of 198 deaf participants in behavioral health, family social service, and educational programs that provide specialized services for deaf individuals was interviewed to obtain clinical diagnoses for current (past 12 months) SUD according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and completed a 42-item version of the Substance Abuse Screener in American Sign Language (SAS-ASL). We used Rasch and discriminant function analyses to reduce the instrument to 28 items, then divided the sample into a development subsample, used to formulate a scoring routine, and a validation subsample to assess correspondence with clinical diagnoses. To provide validation data on the shortened SAS-ASL, an independent sample of 62 respondents was diagnosed and completed the screener. Results: The SAS-ASL instrument demonstrated good person reliability (.85), sensitivity (.90), and specificity (.84) in the primary validation sample, and 100% screening accuracy with 62 respondents in the second validation sample. Conclusion: The SAS-ASL provides a standardized SUD screening for the deaf population. The adaptability of the instrument to electronic administration lends itself to a continuum of technologically supported services for a high-risk population that is disenfranchised for most community-based behavioral health services.

Unsuccessful case closure contributes not only to great financial loss for the federal/state vocational rehabilitation (VR) system but also to consumer disappointment. There is a lack of research on factors related to unsuccessful closure. In this mixed design study, VR consumers from eight states were randomly selected following the Longitudinal Study of the Vocational Rehabilitation Services (LSVRS) weighting schemes. Consumers (n = 111) and matched counselors (n = 54) were asked to identify factors they thought contributed to the unsuccessful closure. Consumer most commonly reported reasons were disability severity (48%), no jobs were available (37%), lack of additional services (33%), and missed appointments (30%). Counselors cited missed appointments (61%), followed by consumers' not being ready for work and disability severity (both 52%), and service refusal (41%). Contrary to our hypotheses, transportation, potential benefit loss, and substance use disorders were not among the most frequent factors cited in unsuccessful closure by either consumers or counselors. The results of this study can assist administrators and vocational counselors in addressing the needs of their consumers. The single most important factors identified by matched consumers and counselors (n = 54 each) were not significantly different and both parties identified disability severity as the most common primary factor in unsuccessful case closure.

Persons who are deaf face a number of challenges with regard to vulnerability for substance use disorders. Moreover, accessible treatment for this condition can be difficult to establish and maintain. The Deaf community may be one of the most disenfranchised groups in America in regard to appropriate access to substance use disorder (SUD) prevention and treatment services. This article reviews findings related to substance use disorder and treatment for this condition among persons who are deaf. It also reviews a promising approach for addressing treatment needs via e-therapy, and it highlights the challenges and concerns regarding e-therapy for this population. E-therapy services demonstrate promise in reaching a larger and therefore more economically viable treatment population of deaf individuals while providing culturally appropriate and comprehensible recovery support options. Demographic and intermediate treatment outcome data are presented on a state-wide program established to serve persons who are deaf in the mid-west.