Designing Deaf-MET: A Deaf-Accessible Pre-Treatment for Alcohol Use Disorder

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PROJECT SUMMARY/ABSTRACT The U.S. Deaf community – more than 500,000 individuals with hearing loss who communicate using American Sign Language (ASL) – experiences nearly triple the rate of lifetime problem drinking compared to the general population. Yet, there are no evidence-based treatments that have been formally validated to treat problem drinking or alcohol use disorder (AUD) among Deaf clients. Available AUD treatments fail to meet Deaf clients’ unique linguistic and cultural needs. Deaf people’s median English reading level falls at the fourth grade and many exhibit low health literacy. Therefore, written treatment materials require plain text revisions, direct ASL translations, or ASL narrative storytelling. Equally critical is the need to incorporate Deaf values and social norms, acknowledge Deaf people’s history of oppression, and respect Deaf people’s identification as a cultural– not a disability – group. Limited awareness and resources lead many hearing clinicians to perceive Deaf people as “disabled” or “impaired,” struggle to develop a collaborative working relationship, and exclude Deaf people from important decisions about their own care. To address these barriers, the proposed K23 study will leverage community-engaged intervention development methods to design, pilot, and refine a culturally- and linguistically-accessible adaptation of Motivational Enhancement Therapy (MET) for Deaf clients with AUD (Deaf-MET). MET is a brief pre-treatment that combines Motivational Interviewing and the stages of change to increase a client’s motivation for actively engaging in recovery. There is strong evidence of MET’s efficacy and a wide selection of evidence-based client tools when used with hearing clients; however, MET fails to meet Deaf people’s linguistic and cultural needs. Guided by the ENGAGED for CHANGE model, a multistep community-engaged process for developing interventions to reduce health disparities, the candidate will design, pilot, and refine Deaf-MET by: (1) assessing Deaf community needs, priorities, and assets via a series of four nationwide focus groups with Deaf people with lived AUD experience and other key stakeholders; (2) in collaboration with a Deaf-engaged intervention development team, developing a prototype Deaf-MET therapist manual and Deaf-accessible MET treatment materials (e.g., visual handouts, ASL translations, ASL narratives, and/or adaptations to the MET script); and, (3) conducting three pilot testing cycles of Deaf-MET with 24 Deaf adults, analyzing key aspects of feasibility (e.g., recruitment, retention, satisfaction) and preliminary efficacy. Results after each pilot testing cycle will be used to refine the Deaf-MET prototype prior to the next cycle. Overall study findings will inform the design of a full-scale RCT of Deaf-MET and contribute to the development of the first Deaf-accessible AUD pre-treatment. Additionally, the proposed aims will provide the candidate with hands-on experience in community-engaged research and intervention development necessary to become an independent clinical researcher who adapts, develops, and evaluates AUD treatments for Deaf clients.