by Dennis P. Morrison, Ph.D.

Imagine an adolescent boy growing up in Indiana with a birth defect resulting in a psychiatric disorder. Even though he has a supportive family, he's emotionally and linguistically delayed. He may never live independently or learn to balance a checkbook.

Perhaps another boy isn't getting the support he needs at home. He might have little family support, or suffer from neglect or abuse. This has led to difficulty in school, fighting with classmates and run-ins with the legal system.

Overcoming or dealing with emotional and behavioral problems is an ordeal in itself. If the adolescent is deaf, finding appropriate support adds to the challenge.

"Kids like this have fragile self-esteem. They may have already failed at other schools and are having difficulty at home," says Andrea Wohl, program manager at Hope House. "They already feel isolated from parents, peers and teachers. To put them with hearing students and staff -- in a 'deaf unit' of a hearing program -- can be frustrating for them."

Over 25,000 people in Indiana are deaf or hard of hearing. Before Hope House opened in Indianapolis in November 1996, deaf adolescents in Indiana who suffered emotional, behavioral, psychiatric or other problems requiring long-term, 24-hour care had nowhere to turn. Deaf adolescents in need of more structure than is available through the public school system were sent to out-of-state programs. These programs thrust the students into unfamiliar surroundings away from friends and family. When they returned they had to readapt to their original environment -- if they didn't end up hospitalized.

While a few programs exist, such as the one at Tri-County Center Inc. in Indianapolis, that provide some services for deaf adults in addition to their other services, Hope House is the first agency in Indiana to provide mental health services specifically for deaf and hard-of-hearing teens and young adults.

"Tri-County's group home is geared toward deaf adults, not adolescents," according to Ms. Wohl. "Hope House catches problems at an earlier point, providing residential living skills, teaching adolescents how to function in a hearing world and determining whether they're ready to go on to college or if they need vocational training."

Modeled after programs in Massachusetts and California, Hope House is a residential program housing up to eight adolescent boys. It is designed to address problem behaviors and teach daily living, social and vocational skills in a secure environment. Days are highly structured, with a schedule of meal times, classes, household duties, recreation time and lights out. The house itself is designed especially for the needs of deaf students, with flashing alarm clocks, blinking lights to signal the doorbell and pulsing red lights for fire alarms. The staff members, including a case manager, therapist, teachers, overnight aids and mental health technicians, are all fluent in American Sign Language. Hope House plans to open a girls' program in the future.

"We believe in providing deaf role-models, language, culture, support and treatment for adolescents and their families," says Wohl. "This is a self-contained program for the deaf, not just a 'deaf wing' or a learning resource laboratory. That makes us unique from just about any other program in the United States"

"We're extremely pleased to have a facility like Hope House in Indiana," says George Stailey, superintendent of the Indiana School for the Deaf (ISD). "As is the case for many states, there has definitely been a service gap -- mental health services are available for hearing adolescents and hearing and deaf adults who need hospitalization or alternative programming, but we haven't had anything appropriate for deaf children. We look to Hope House as a point between being hospitalized and returning to the School for the Deaf."

Stailey says that some students at the School for the Deaf who have emotional and behavioral problems may need Hope House four or five hours a day. Other students may live at Hope House 24-hours a day in order to benefit from the smaller community, increased structure, emotional support and guidance. Stailey says these are things that the School for the Deaf is not set up to provide.

"These students have been difficult to serve in Indiana," he says. "Some make academic progress, but behavior problems interfere with their relationships with other students and staff. We've tried to serve them here at ISD, but we don't have the physical structure or staff. Since our function is education, our structure and resources follow education."

Generally, Hope House works to get students back into the community, back into the School for the Deaf or back into mainstream hearing classrooms. After such a goal is identified, the staff determines what the student needs to succeed in that environment: What will he need to know? What kind of coping skills, such as managing anger, does he need to learn? Where will he go for counseling, or for help managing bills?

A key emphasis at Hope House is to provide behavioral support while exposing the adolescents to deaf culture. Sarah Rosen, case manager at Hope House says, "For most emotionally disturbed, deaf adolescents, problems stem from a lack of communication in their home environment. No one else in their family may know sign language. They may be the only deaf student in their school. They just haven't been introduced to deaf culture." Hope House provides such exposure. Eleven of the 13 staff members are deaf themselves, and students are taken on field trips and receive visits from deaf speakers who discuss their challenges and successes. The staff will weed out those mislabeled as emotionally disturbed who are frustrated by a lack of communication skills on their part or that of their family and peers.

"Some students don't have any idea what their potential is," says Rosen. "We bring in deaf role-models, and the students can say, 'Oh, I can be successful. I can be like you. I can work, and I don't have to be on welfare.' "

Wohl adds that her hope for Hope House is that by providing culturally sensitive therapeutic intervention, these adolescents will find strength from their deaf community and a haven in their families. "Many deaf children in hearing families and communities feel like strangers even in their own home," says Wohl. "Hope House aims to provide a community of people who are the same as they are, a community of teachers, peers and role models they can draw strength from when they're out in the world."

Dennis Morrison is CEO of the Center for Behavioral Health in Bloomington, Ind., and is author and national presenter on issues in behavioral treatment and outcomes assessment. (812/339-1691)